Health Information Management

Public comments highlight provider concerns with CMS' 2016 OPPS proposals

APCs Insider, October 9, 2015

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By Steven Andrews

Despite dealing with the final touches for ICD-10 implementation, providers submitted more comments to CMS regarding the 2016 OPPS proposed rule than they did last year for the 2015 rule, but still far less than in other recent years.

Providers submitted 648 comments electronically for the 2016 OPPS proposed rule, according to, which doesn’t include a count of hardcopy entries. That’s up from the 606 comments submitted for last year’s proposed rule, but much lower than the 1,500 submitted regarding the 2014 rule, in which CMS proposed massive E/M changes and introduced comprehensive APCs (C-APC). Providers also submitted more than 1,100 comments for the 2012 proposed rule.

Of those 648 comments, more than 140 of them focus on CMS’ proposed changes to the 2-midnight rule. Providers expected changes to be included in April’s 2016 IPPS proposed rule, but CMS deferred to this year’s OPPS proposed rule. Many commenters appreciate CMS shifting responsibility for education and enforcement to Quality Improvement Organizations but still find aspects of the rule difficult to implement. Many commenters proposed that CMS consider a rule stating that patients staying one midnight be admitted, unless the patient came at night to the ED or was there for one night of recovery following surgery.

More than 140 commenters also offered their thoughts to CMS regarding new C-APCs. Of the comments I reviewed, providers did not have a problem with the concept or formulation of C-APCs but did urge CMS to be more transparent about all of the costs packaged into each service. This will become a very important issue for the industry as the OPPS moves further down the road of becoming a true prospective payment system.

The final rule is expected to be published by the first week of November. For a comprehensive analysis of the rule, listen to HCPro’s annual OPPS final rule webcast from 1–2:30 p.m. (Eastern) on Tuesday, December 8, featuring Jugna Shah, MPH, and Valerie A. Rinkle, MPA.

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