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2017 Hospital Outpatient and ASC Prospective Payment System Highlights

2017 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Highlights

On November 1, 2016, CMS released its final 2017 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule implementing site-neutral payment provisions of the Bipartisan Budget Act of 2015.

Site-neutral payment provisions

CMS is implementing Section 603 of the Bipartisan Budget Act of 2015. Under this section, certain off-campus provider-based departments (PBD) that began billing under the OPPS on or after Nov. 2, 2015, will no longer be paid for most services under the OPPS. Instead, beginning Jan. 1, 2017, these facilities will be paid under the physician fee schedule. However, services provided in a dedicated emergency department will continue to be paid under the OPPS.

Under the final rule, CMS put certain restrictions on off-campus PBDs that began billing under the OPPS prior to Nov. 2, 2015. The agency finalized a proposal requiring these departments to provide services and bill from the same physical address as they did Nov. 2, 2015, to be exempt from the site-neutral payment provisions.

However, there are still certain proposals that CMS has not finalized. For instance, the agency is still working on a proposal that would allow off-campus PBDs to maintain excepted status if the hospital is sold and the new owner accepts the existing Medicare provider agreement.

Payment update

CMS will increase OPPS rates by 1.65 percent in 2017. CMS arrived at the rate increase through the following updates: a positive 2.7 percent market basket update, a negative 0.3 percent update for a productivity adjustment and a negative 0.75 percent update for cuts under the ACA. After considering all other policy changes included in the final rule, CMS estimates OPPS payments will increase by 1.7 percent in 2017.

Hospital Outpatient Quality Reporting Program

For 2017, CMS is adding seven measures to the Hospital Outpatient Quality Reporting Program for the 2020 payment determination and subsequent years.