In addition to bringing numerous changes to various coding systems, 2018 will also usher in a brand new set of updates for the hospital Outpatient Prospective Payment System, or OPPS. Though the official document is well over 1,000 pages long, this article is designed to give a brief overview of the final adjustments, which were officially published on November 13th.
For 2018, the APC guidelines, also known as Ambulatory Payment Classifications, will be tweaked. APC payments will rise 1.35%, while ASC (ambulatory surgical center) payments are increasing by a similar 1.2%. A host of other APC updates will also take effect, particularly in the areas of cardiac telemetry, care management, and the musculoskeletal series of codes.
Under the skin substitutes category, CMS plans to study this area in terms of separate versus packaged payments. Similarly, CMS is working to package device payments so that it does not have to cover devices individually. CMS also plans not to change its physician supervision rules (which stated that all outpatient therapeutic services require physician supervision) for small rural hospitals and critical access hospitals (CAHs); instead, it is opting to apply “non-enforcement” to the supervisory policies for these areas.
As with many other systems, OPPS is adjusting in the wake of the CMS announcement that it is reducing drug reimbursement. Drugs falling under the 340B category will be monitored and paid for differently, though this change will not affect sole community hospitals, children’s hospitals, and PPS-exempt cancer hospitals.
Policies regarding emergency department visits, hospital clinic visits, and critical care services will remain unchanged. Additionally, the decision was made to not implement the identification of new service lines within provider-based clinics. Finally, the document announced plans to remove OP-21 (Median Time to Pain Management by Long Bone Fracture) and OP-26 (Hospital Outpatient Volume Data on Selected Outpatient Surgical Procedures) in 2020.