CMS Publishes Final OPPS Rule for 2017

Members & Publications


November 10, 2016

The final Outpatient Prospective Payment System (OPPS) rule (with comment period) was published in the Federal Register on November 14, 2016. The Centers for Medicare & Medicaid Services (CMS) will accept comments on the OPPS final rule through Dec. 31. Among additional items, some of the new information contained in the OPPS rule include:

  • For 2017, CMS is adding 7 measures to the Hospital Outpatient Quality Reporting Program for the 2020 payment determination and subsequent years.
  • CMS is implementing the provision that certain off-campus provider-based departments that began billing under the OPPS on or after Nov. 2, 2015, will no longer be paid for most services under the OPPS. Instead, beginning Jan. 1, 2017, these facilities will be paid under the physician fee schedule. There are certain exceptions.
  • To be exempt from the above site-neutral payment provisions, off-campus provider based departments that began billing under the OPPS prior to Nov. 2, 2015 must provide services and bill from the same physical address as they did Nov. 2, 2015, with limited exceptions.
  • CMS has finalized a 90-day EHR reporting period in 2016 and 2017 for all eligible professionals and hospitals. The reporting period will be any continuous 90-day period between Jan. 1 and Dec. 31 in 2016 and 2017. This allows more flexibility than the previous rule.


Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.