AGuidetoRegulationandLegislation

Volume five of CLA’s Regulatory Advisor helps leaders of hospitals and physician practices understand the key points and changes in CMS’ proposed rule.

Navigating health reform

Regulatory Advisor: 2017 Proposed Rule for Outpatient PPS and Ambulatory Surgery Centers

  • 10/17/2016

On July 6, 2016, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would update payment rates for services provided to Medicare beneficiaries in hospital outpatient departments (HOPDs) and ambulatory surgical centers for the calendar year beginning January 1, 2017.

Read the full Regulatory Advisor

The proposed rule demonstrates CMS’ commitment to further packaging services for single payment. CMS estimates that the overall impact of the proposed payment rate changes to Outpatient Prospective Payment Systems (OPPS), as well as other changes discussed in the proposed rule, will result in a $5.1 billion increase in Medicare spending in calendar year (CY) 2017 compared to CY 2016.

CMS accepted comments on the proposed rule until September 6, 2016, and responses to comments will be included in the final CY 2017 rule to be issued in November 2016. CliftonLarsonAllen (CLA) monitors CMS publications and will release additional guidance as information becomes available.

Issues discussed in this volume include:

  • Health Care Common Procedure Coding System (HCPCS) P-Codes
  • Packaging policies
  • Section 603 implementation: off-campus departments of a provider
  • The Hospital Outpatient Quality Reporting (OQR) Program

The CLA Regulatory Advisor offers a summary of key provisions of the proposed rule and translates some of the more complex issues into understandable terms. CLA provides this resource to help keep you informed as new legislation is enacted.

Regulatory Advisor