WSHA Provides Reports and Analyses of Medicare Outpatient Rule to Hospitals

December 2, 2015

On November 20, WSHA provided hospitals with an analysis of the Calendar Year 2016 Medicare outpatient prospective payment system final rule.  WSHA also provided facility-specific impact reports to hospital Chief Financial Officers.  The new payment rates include a 2.1 percent market basket increase that is offset by an ACA-mandated reduction of 0.7 percent and an additional adjustment reduction of 2 percent due to lab services that should have been bundled being paid separately in error.  In aggregate, Washington hospitals will experience a slight increase in payment compared to 2015, mainly due to changes in wage index.  The scope of impact for Washington hospitals ranges from a negative 7.5 percent to a positive 9.5 percent.

The rule also includes:

  • Renumbering of APCs in order to better group clinical families.
  • Implementation of 10 new Comprehensive Ambulatory Payment Classifications (C-APCs) that bundle all payments for certain device-dependent procedures.
  • Expansion of the list of services to be packaged into APCs as opposed to separately paid.
  • For IPPS, revision of the “Two-Midnight Rule” for reasonable expectation requirement and use of Quality Improvement Organizations (QIOs) as the first line for auditing.
  • Updated payment rates and policies for Ambulatory Surgical Centers (ASCs).


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