SOURCE: LogixHealth

LogixHealth

January 29, 2016 11:00 ET

LogixHealth Publishes ED Facility-Focused Intelligence Briefing: 2016 Emergency Department Outpatient Payment System Update

BEDFORD, MA--(Marketwired - Jan 29, 2016) - LogixHealth has published its newest facility-focused Intelligence Briefing: 2016 Emergency Department Outpatient Payment System Update. On November 30, 2015, CMS published the 2016 Outpatient Prospective Payment System (OPPS) final rule in the Federal Register, which finalizes payment rates and policies for outpatient services furnished by hospitals that are paid under the OPPS, and governs services provided on or after January 1, 2016. The rule, and the full 2016 Emergency Department Outpatient Payment System Update can be found on the LogixHealth website.

The Facility Conversion Factor
For 2016, the payment rates under OPPS will decrease 0.3%. The unadjusted conversion factor decreases from $74.173 in 2015 to $73.725 in 2016. The negative update is driven by a 2% correction resulting from "excess packaged payments" for laboratory tests that were excluded from packaging in the 2014 final rule.

ED Facility E/M Level Guidelines
For 2016, there are no significant changes to the rules governing ED facility E/M level guidelines. Hospitals will be allowed to utilize their own scoring systems provided they accurately reflect facility resource utilization and are consistent with the 11 guiding principles published in the 2008 OPPS final rule.

While in the past years CMS has shown an intent to explore a single set of national ED facility guidelines, in the 2016 final rule, CMS states this has been a complex endeavor and that it does not have a timetable for creating national guidelines.

Observation
In 2008, CMS adopted the composite APC methodology, reimbursing ED facility and observation services in a single packed construct. For 2016, the packaged/composite methodology continues to combine ED and observation services into a single APC. The observation composite APC reimbursement has been steadily increasing over the past several years.

"In 2016, CMS will make a dramatic 76% payment increase to $2,174 for Observation and package most ancillary services such as labs, CT scans, and infusions. Physician utilization choices will have an increased financial impact on hospitals." - Elijah Berg, M.D., CEO of LogixHealth.

About LogixHealth:
With two decades of experience providing coding, billing and end-to-end revenue cycle services for top hospitals, office based practices and emergency departments in over 30 states nationwide, LogixHealth offers healthcare providers the tools and resources needed to optimize their practices and improve the overall delivery of care. For more information, visit www.logixhealth.com.

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