BEDFORD, MA--(Marketwired - Mar 28, 2017) - LogixHealth, a leading provider of internet and software enabled coding, billing, analytics and management services for hospital and physician practices nationwide, provides services for millions of Emergency Department (ED) visits nationwide, and has published its newest facility-focused intelligence briefing: 2017 Emergency Department Outpatient Payment System Update. On November 1, 2016, CMS published the 2017 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, 2017. The rule, and the full 2017 Emergency Department Outpatient Payment System Update can be found on the LogixHealth website.
The Facility Conversion Factor
For 2017, CMS is updating OPPS rates by 1.65%. The change is based on the projected hospital market basket increase of 2.7% minus both a 0.3 percentage point adjustment for multi-factor productivity (MFP) and a 0.75 percentage point adjustment required by the Affordable Care Act. The unadjusted conversion factor under OPPS will increase from the 2016 OPPS conversion factor of $73.725 to $75.001. After considering all other policy changes finalized under the OPPS, including estimated spending for pass-through payments, CMS estimates a 1.7% payment increase for hospitals paid under the OPPS in 2017.
ED Facility E/M Level Guidelines
For 2017, 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 intent to explore a single set of national ED facility guidelines, CMS now continues to express diminished interest in nationally mandated guidelines.
"In the CY 2017 OPPS/ASC proposed rule (81 FR 45667), for CY 2017, we proposed to continue with and did not propose any changes to our current clinic and emergency department (ED) hospital outpatient visits payment policies. We did not receive any public comments on this proposal. Therefore we are finalizing our CY 2017 proposal, without modification, to continue our current clinic and ED hospital outpatient visits and critical care services payment policies." 2017 OPPS final rule, page 482/1378
In 2008, CMS adopted the composite APC methodology, reimbursing ED facility and observation services in a single packed construct. For 2017, 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. With the Observation APC (8011) reimbursing $2,221.70 for 2017
"In 2017, CMS will continue to escalate facility payment for observation services along with packaging 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.
LogixHealth, a leading provider of internet and software enabled coding, billing, analytics and management services for hospital and physician practices nationwide, provides services for millions of Emergency Department (ED) visits nationwide. We provide tools and resources to optimize financial performance and improve the quality of care. For more information, visit www.logixhealth.com.