Health Information Management

Tip: CMS issues first OPPS negative payment update

APCs Insider, January 8, 2016

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CMS finalized its proposal to reduce the conversion factor by 2% to account for its overestimation of dollars for packaged labs built into the 2014 APC rates, despite congressional and provider pressure to not proceed with this payment reduction.
The 2% reduction, along with other adjustments, results in decreasing APC payment rates under the OPPS by 0.3% in 2016. This will lower payments to hospitals by approximately $133 million compared to 2015, excluding estimated changes in enrollment, utilization, and case mix.
CMS will also continue to implement a statutory 2% payment reduction for hospitals that fail to meet hospital outpatient quality reporting requirements.


This tip is adapted from “CMS backs off some burdensome proposals but imposes negative payment update in latest rule” in the January issue of Briefings on APCs.

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