OPPS/APC Update for 2017

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

Final Changes in OPPS/APCs for 2017

In the form of APCs, OPPS is being changed significantly. These final changes for the year 2017 continue to significantly involve increased packaging in several forms. Further, the changes for device dependent APCs along with changes generated to by cost reporting changes. In addition to the composite APCs, comprehensive APCs are also being developed. These changes started in 2008 and continue to accelerate with particular attention relative to observation services. Given additional changes for CPT and HCPCS, the impact of changes for APCs are revolutional as opposed to evolutional.

This session by expert speaker Duane C. Abbey, Ph.D., CFP will answer some questions such as:

  • What does increased bundling under APCs mean for our hospital?
  • Why APCs have not stabilized so that there are minimal year changes?
  • Whether there are new special compliance concerns?
  • What is happening with observation services?
  • How changes in cost reporting process affect APCs?
  • What are the general trends for the evolution of APCs?
  • How CMS views add-on codes for payment purposes?
  • Difference between composite APCs and comprehensive APCs?
  • Whether rural EACHs and SCHs are affected by the proposed changes?
  • What is all the fuss about status indicators?
  • What about other payment mechanisms such as copayment amounts and cost outliers?

Session Objectives

  • To review the many proposed and finalized changes to APCs for 2017.
  • To recognize the general trends for APCs with particular attention to increased bundling.
  • To appreciate changes made relative to observation services, associated packaging and the need for special billing for packaged items that are not normally paid through APCs.
  • To understand how recent changes in the cost reporting process affect APCs payments.
  • To understand the complex nature of APCs and associated compliance issues including RAC concerns.
  • To review changes in grouping with particular attention to new CPT and HCPCS codes.
  • To appreciate the potential financial and operational impact of the proposed changes.
  • To understand how important it is for hospitals to comment to the proposed changes.
  • To understand the difference between composite and comprehensive APCs.
  • To review the possible impact of the proposed change on high impact areas such as observation, the Emergency Department, interventional radiology and associated areas.
  • To review changes to and trends for the Provider-Based Rule (PBR).
  • To discuss anticipated future changes and directions for APCs.

Session Highlights

  • Review of APC Final Changes for CY2017
    • Coding/Grouping Changes
    • E/M Coding
    • Recalibration of APC Weights
    • On-Going Problem Areas
    • Cost Report Changes – Charge Compression
    • Drugs and Biologics
    • Cost Outliers
    • Interventional Radiology
    • Additional Comprehensive APCs
    • Inpatient-Only Procedures
  • APC Trends
    • Increased Bundling and Packaging
    • Comprehensive APCs
    • Shifts In Realigning Payments
    • Development of Comprehensive APCs
    • Policy and Interpretive Changes
    • Impacts of CPT/HCPCS Changes
  • Provider-Based Clinic Changes
    • CMS Information Collection
    • BBA 2015 – Section 603
    • Projecting the Future for Provider-Based Clinics
  • Associated Proposed APC Changes
    • Ambulatory Surgery Centers
    • Related Physician Changes
    • Clinical Service Area Considerations
    • RAC Audit Concerns
  • Assessing the Impact of Proposed Changes
    • Financial Impacts
    • Coding and Billing Impacts
    • Other Operational Impacts
    • APC Compliance Issues
  • The Future for APCs

Prerequisites for Participating:

General knowledge of outpatient services and APCs.

Who Should Attend

  • Outpatient Clinical Staff
  • Nursing Staff
  • Physicians
  • Outpatient Departmental Managers
  • Nurse Auditors
  • ED Nursing Staff
  • Provider-Based Clinic Nursing Staff
  • Coding Personnel
  • Coding, Billing and Claims Transaction Personnel
  • Internal Auditing Personnel
  • Financial Analysts
  • Revenue Cycle Specialists
  • Compliance Personnel
  • Cost Accounting Personnel
  • Chargemaster Coordinators
  • Cost Reporting Personnel
  • Other Interested Personnel

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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
More Events By The Speaker

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