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CMS OPPS 2017 Final Rule shows changes to Provider Based Status

CMS Final Rule

CMS recently released the Outpatient Prospective Payment System (OPPS) Final Rule for 2017. For organizations that have provider-based clinics, this year’s final rule offers guidance as to the changes in how reimbursement will be handled. Let’s take a look at what’s changing.

2017: What’s New

Updates to Section 603 – Provider-Based Status

  • From CMS: “CMS issued an Interim Final Rule with comment period (IFC) to establish Medicare Physician Fee Schedule (MPFS) rates for certain items and services furnished by certain off-campus outpatient departments of a provider (hereinafter referenced as off-campus provider-based departments (PBDs)) to address changes required by Section 603 of the Bipartisan Budget Act of 2015.”

This includes:

  • An increase of 1.65% updates to OPPS rates for 2017
  • Addition of 25 new Comprehensive APCs (C-APC)
  • Discontinuation of the L1 modifier for unrelated laboratory tests
  • And much more!

What do provider organizations need to know?

 The deadline for implementation is January 1, 2017.  All CPT, HCPCS codes, and operational changes will need to be made and tested before this date to ensure compliant charge capture. 

Where can I find additional detail?

CMS has a number of excellent references: