News & Publications

News Details

CMS Publishes Final OPPS Rule for 2017

Nov 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.