2014 Final OPPS Rule

On November 27, 2013, CMS published a display copy of the 2014 Outpatient Prospective Payment System (OPPS) Final Rule. Implementation of the final rule is effective January 1, 2014.

Key provisions include:

  • 1.7% payment increase.
    • Payment reductions for hospitals that fail to comply with quality reporting will be applied.
  • Adoption of the proposal to collapse outpatient evaluation and management (E/M) services into a single level.
    • Does NOT apply to emergency department.
    • All other outpatient E/M services will be reported with HCPCS code G0463 (Hospital outpatient clinic visit for assessment and management of a patient) and Ambulatory Payment Classification (APC) 0634.
  • Packaging of certain drugs, laboratory tests and biologicals.
  • Revisions to the electronic health records (EHR) incentive program.

With only 29 days to implement the substantial changes in E/M reporting and new packaging rules, providers will likely need to turn to outside experts to assist with Charge Description Master (CDM) revisions and employee training. We also anticipate providers will see a reduction in reimbursement for their outpatient clinics and departments due to the new reimbursement policy for E/M services. It would benefit most providers to conduct a charge capture review to ensure all reportable charges are being submitted for reimbursement.

HC Healthcare Consulting staff includes CDM experts, certified coders, consultants certified in healthcare compliance, physicians and statisticians that are available to provide expert assistance with revisions to your to your CDM and provide charge capture and other auditing services along with training and education for your staff.

The complete final rule may be viewed at http://www.ofr.gov/OFRUpload/OFRData/2013-28737_PI.pdf

DISCLAIMER: This post contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link. Any advice or recommendations given is general and specific questions should be directed to professional counsel.

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