CY 2016 OPPS Proposed Rule – Understand CMS’ Proposed Changes for OPPS/APCs in 2016

Event Information
Product Format
Prerecorded Event
Conference Date
Thu, Aug 13, 2015
100 minutes
Product Description

Review Major Financial and/or Operational Changes Being Proposed By CMS for CY 2016 OPPS

On July 1, 2015, the Centers for Medicare & Medicaid Services (CMS) released the CY 2016 Outpatient Prospective Payment System (OPPS) Proposed Rule.

The Proposed Rule brings Medicare payment policy and rate updates, and changes the “2-Midnight Rule,” permitting Medicare Part A inpatient hospital reimbursement for certain short inpatient stays. Inpatient services are generally reimbursed at a higher rate than the same services performed in an outpatient setting.Providers who are aware of CMS’ proposed changes to the outpatient payment system can weigh in by sending official comments to staff. This is important because sometimes the proposed changes if finalized could be detrimental to provider workload, operations, and the bottom line. It’s also helpful for providers to get a preview of the direction CMS is headed in early before all changes are finalized. This information will help you, as a provider, to familiarize with the changes that might be required once the final rule is released in November.

Join expert speaker Jugna Shah, MPH in this educative session to get useful information on the major proposed changes for OPPS and APC in 2016, and its expected impact. She will also provide information on key issues to comment to the CMS on, and information on how to submit comments to the CMS.

Session Highlights:

  • Review all major financial and/or operational changes being proposed by CMS for CY 2016 OPPS
  • Review and update of Status Indicators related to packaging
  • Packaging proposals for CY 2016
  • Know the comprehensive APC changes
  • Reclassification of HCPCS/CPT® codes and APC system recalibration
  • Review of Addendum B & OPPS Status Indicators
  • Learn about the Lab Services Packaging expansion
  • Know about the payment rate changes for:
    • Drug administration
    • E/M visit codes
    • Observation
    • Composite APCs
    • Drugs
    • Biologicals
    • Radiopharmaceuticals
    • Blood and blood products
    • Other major APC categories
    • Learn the changes related to reporting modifiers
    • Estimating financial impact across your book of business
    • Review the site of service changes

Session Agenda:

Sec I – General Annual Proposed Updates for CY 2016

  • Market Basket Update and the Conversion Factor
  • Protected Hospitals
  • Outlier Payment Policy

Sec II – Major CY 2016 Proposed Changes

  • Annual Reclassification and Recalibration Related Changes
  • Status Indicators and Comment Indicators
  • APC Restructuring and Consolidation
  • Packaging
  • Comprehensive APCs (CAPCs)
  • Assessing Financial Impact

Section III – Round-Up of Other Items From the Proposed Rule

  • Two-Midnight Rule
  • Inpatient-Only List
  • Device Intensive Procedure APCs
  • Composite APCs, E/M Visits, and Drug Administration
  • Drugs, Biologicals, Radiopharmaceuticals and Pass-Through Items
  • CT Equipment – Meeting NEMA Standards
  • Partial Hospitalization
  • Quality Reporting Requirements
  • Ambulatory Surgery Centers

Section IV – Summary and Q&A

Who should attend

Health Information Management, Revenue Cycle Directors, Finance, Billing Office, Charge Description Master Coordinators, others in the hospital interested in understanding the changes CMS is proposing for CY 2016.


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About Our Speaker

jugna Shah - Hospitals & Healthcare System Coding Expert

Jugna Shah, MPH, is the president and founder of Nimitt Consulting Inc. and specializes in working with hospitals, health systems, advocacy organizations, and international governments on regulatory and health care financing issues. In the U.S., Ms. Shah works with hospitals to manage the clinical and financial operations related to OPPS/APCs.

She also raises important payment system issues to Medicare and the APC Advisory Panel to improve the APC...   More Info
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