Webinar on CY 2017 OPPS Proposed Rule: Financial, Operational and Section 603 Implications for Off vs. On-Campus Providers
Overview: Medicare releases proposed payment rate and operational changes each July for the upcoming year's outpatient prospective payment system (OPPS) and providers who are aware of CMS' proposed changes can weigh in by sending official comments to agency staff. This is critical as many of the proposed changes if finalized could be detrimental to provider operations, finance/the bottom line, and overall staff work load. Moreover, providers weighing in have an opportunity to influence CMS and at a minimum can get a preview of the direction CMS is headed in before all changes are finalized in November which only gives providers less than 60 days to be ready for the new year's changes.
The CY 2017 OPPS proposed rule is expected to jam-packed with all of the usual items, but also items related to the observation notice requirements and implementation issues related to section 603 regarding new/non-grandfathered off-campus provider based clinics, Part B drug payment changes, and more.
Why should you Attend: It's better to know early on what CMS is proposing to change for the upcoming year, especially when it can impact provider operations such as new billing requirements or use of modifiers, etc. Additionally, providers can get an early preview of payment rate changes/shifts that are expected to occur for individual services (by CPT code, such as evaluation and management visits, observation, drugs, etc.) and/or for Comprehensive APCs, which are like mini-outpatient DRGs or episodes. Knowing what CMS is planning for the upcoming year can help finance directors, hospital CFOs, coding, billing, reimbursement, and compliance staff better understand what sort of impact they may have if changes are finalized and also gives hospitals time to weigh in on changes and influence/impact CMS' proposals before it's too late.
Areas Covered in the Session:
- Information on the major proposed changes and expected impact
- Information on key issues to comment to CMS on
- Information on how to submit comments to CMS
- All major financial and/or operational changes being proposed by CMS for CY 2017 OPPS
- Status indicator changes
- Packaging changes
- Comprehensive APC (mini-DRG) changes
- Payment changes for drug administration, E/M visit codes, observation, composite APCs, drugs, biologicals, radiopharmaceuticals, blood and blood products, as well as other major APC category payment rate changes
- Changes related to reporting modifiers and much more!
- Observation Notice Act changes if released
- Section 603 related technical and operational changes for grandfathered vs. non-grandfathered provider-based off-campus locations
- And much more!
Who Will Benefit:
- Health Information Management
- Revenue Cycle Directors
- Billing Office
- Charge Description Master Coordinators
- Others in the hospital interested in understanding the changes CMS has finalized for CY 2017.
Jugna Shah is a Nationally recognized expert in health care policy and financing reform and the founder of Nimitt Consulting, Inc. Since 2001, Nimitt Consulting has specialized in providing information and education on regulatory initiatives and policies that affect health care service delivery, quality, cost, accessibility, and compliance.
In the U.S., Ms. Shah works with a variety of hospitals and health systems to address the clinical, operational, and financial challenges they face under Medicare's payment systems - specifically, Medicare's Outpatient Prospective Payment System (OPPS), based on Ambulatory Payment Classifications (APCs). She helps providers address and overcome complex coding, billing, revenue cycle, and compliance issues, with a focus on medical and radiation oncology, pharmacy and drug coverage, radiology, use and refinement of E/M visit guidelines, and more. In addition to working with providers, Nimitt Consulting provides expertise on reimbursement and policy to drug and device manufacturers, trade associations, and law firms.
A successful advocate, Ms. Shah has raised important payment system concerns to the Centers for Medicaid and Medicare Services (CMS) and the federal Advisory Panel on APCs. Many of her recommendations have been accepted and implemented by CMS, thereby making the APC system not only operationally simpler but also more equitable for providers nationwide. Nimitt Consulting Inc. also works internationally on case-mix design, system development, and implementation initiatives. Ms. Shah has led several World Bank and US Agency for International Development (USAID) health care financing reform initiatives that involve providing long-term policy and technical assistance to foreign governments. She has worked in Albania, Bulgaria, the Czech Republic, Hungary, Iceland, the Republic of Moldova, Romania, Turkey, and Slovakia. Since 2007, Ms. Shah has served as Secretary for Patient Classification Systems International (PCSI), an international case-mix organization and was recently elected to Vice-President.
Ms. Shah is a popular and dynamic educator who regularly presents on OPPS, APCs, and related topics. She is a frequent speaker at local, regional, national, and international conferences including the Healthcare Financial Management Association (HFMA), the American Health Information Management Association (AHIMA), HCPro, and Ingenix. She is also a lead instructor at the PCSI case-mix summer school held annually in June. As part of her commitment to education, Ms. Shah helped create several of the field's leading publications on OPPS/APCs, including HCPRO's APC Answer Letter, The APC Weekly Monitor, and Briefings on APCs. She is also the author of several books, including OPPS Drug Administration Strategies: Your Comprehensive Guide to Accurate Coding, Billing and Charging and The Drug Revenue Toolkit.
Prior to founding Nimitt Consulting, Inc., Ms. Shah was a senior manager with KPMG's Assurance-Based Advisory Services Practice, guiding providers through the clinical and financial implications of APC implementation. Previously, Ms. Shah worked with 3M Health Information Systems as an Ambulatory Care Product Marketing Manager. She holds a Bachelors of Science in Biopsychology from Oberlin College, and a Masters of Public Health Policy & Administration from the University of Michigan.
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