OPPS/APCs Final Changes for 2018

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

Understand the Financial and Operational Impact of Final Changes to OPPS and APCs in 2018

The Outpatient Prospective Payment System (OPPS), in the form of Ambulatory Payment Classifications (APCs), is now being significantly changed. The final changes for 2018 continue to involve significantly increased packaging in several forms. Cost reporting changes are leading to further changes to device dependent APCs, and along with composite APCs, comprehensive APCs are now also part of the picture. These changes started in 2008 and continue to accelerate with particular attention relative to observation services. Coupled with the additional changes to CPT and HCPCS, the impact of changes for APCs is revolutional as opposed to evolutional. In addition, provider-based clinics are being impacted with the implementation of Section 603 of BiBA 2015. You must understand the potential financial and operational impact these changes will have.

Join this session with expert speaker Duane C. Abbey, who will provide an overview of the proposed and finalized APC changes for 2017 and what anticipated changes the future will hold for APCs. Duane will also review changes in the grouping of the new CPT and HCPCS codes. He will review changes to and trends for the Provider-Based Rule (PBR) and the implementation of Section 603 of BiBA 2015.

Session Objectives

This session will address the following questions:

  • Why haven’t APCs stabilized so that the year changes are minimal?
  • What does the increased bundling under APCs mean for your hospital?
  • What is happening with observation services?
  • Are there new special compliance concerns?
  • What are the general trends for the evolution of APCs?
  • How are changes in the cost reporting process affecting APCs?
  • What is the difference between composite versus comprehensive APCs?
  • How is CMS viewing add-on codes for payment purposes?
  • What is all the fuss about status indicators?
  • Are rural SCHs and EACHs affected by the proposed changes?
  • What about all of the other payment mechanisms such as cost outliers and copayment amounts?
  • How are provider-based clinics impacted by implementation of Section 603 of BiBA 2015?

Session Highlights

  • Review the many proposed and finalized changes to APCs for 2017
  • Recognize the general trends for APCs with particular attention to increased bundling
  • 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
  • Understand how recent changes in the cost reporting process affect APCs payments
  • Understand the complex nature of APCs and associated compliance issues including RAC concerns
  • Review changes in grouping with particular attention to new CPT and HCPCS codes
  • Appreciate the potential financial and operational impact of the proposed changes
  • Understand how important it is for hospitals to comment to the proposed changes
  • Understand the difference between composite and comprehensive APCs
  • Review the possible impact of the proposed change on high impact areas such as observation, the Emergency Department, interventional radiology and associated areas
  • Review changes to and trends for the Provider-Based Rule (PBR) and the implementation of Section 603 of BiBA 2015
  • Discuss anticipated future changes and directions for APCs

Session Agenda

  • Review of APC final changes for 2018
  • Recognize the general trends for APCs in regards to increased bundling
  • How recent cost reporting process changes affect APC payments
  • Potential financial and operational impact of the proposed changes
  • How APCs are increasing becoming complex
  • Wide variations in payments year after year
  • Tracking and verifying that correct payment is received
  • Major issues with hospital charges, CCRs and the cost report
  • Citations to the federal register
  • Overview of key issues related to the final update
  • APC background information, fundamentals, weight, hospital charges conversion, and more
  • Use of claims to statistically develop the APC weights
  • Provider-based rule: 42 CFR §413.65
  • What are ambulatory surgical centers
  • APC specific changes/considerations
  • Recalibration of APC relative payment weights
  • Challenges with comprehensive APC assignment logic
  • Recalibration of APC relative payment weights
  • Final changes: Observation C-APC 8011
  • Inpatient-only composite APC 5881
  • Conditionally packaged ancillary services
  • Final OPPS payment for hospital outpatient visits
  • Chronic care management services

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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