OPPS/APCs Final Changes for 2019

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

Prepare for the Key Changes for 2019 under OPPS


Each year, CMS issues the rule for hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment systems, detailing the changes to Medicare outpatient coding and billing. Hospitals must know how to prepare for and implement the major changes for 2019 under OPPS. There are many significant changes, and some of them are revolutional as opposed to evolutional – such as those for Ambulatory Payment Classifications (APCs).

Join this session with healthcare expert Duane C. Abbey, who will update you on the major changes for 2019 under OPPS, and shed light on what changes the future holds for APCs. Abbey will walk you through the changes in the grouping of the new CPT and HCPCS codes; changes to and trends for the Provider-Based Rule (PBR); how provider-based clinics are being impacted with the implementation of Section 603 of BiBA 2015, and the additional guidance that is being provided. Abbey will explain why APCs have not stabilized; the general trends for the evolution of APCs, including significantly increased packaging in several forms; how CMS is viewing add-on codes for payment purposes; whether there are new special compliance concerns; the fuss about status indicators, and more.

After attending this session, you will learn how to prepare for and implement the key changes for 2019 under OPPS. You will also understand the complex nature of APCs and compliance issues, including RAC concerns, as well as how the recent changes in the cost reporting process will affect APCs payments.

Session Highlights

This session will bring you up to speed with:

  • Proposed and finalized changes to APCs for 2019
  • General trends for APCs with particular attention to increased bundling
  • Changes to observation services, associated packaging, and the need for special billing for packaged items that are not normally paid through APCs
  • How recent changes in the cost reporting process affect APC payments
  • How to understand the complex nature of APCs and associated compliance issues, including RAC concerns
  • Changes in grouping, with particular attention to new CPT and HCPCS codes
  • Potential financial and operational impact of the proposed changes
  • How important it is for hospitals to comment on the proposed changes
  • Difference between composite and comprehensive APCs
  • Possible impact of the proposed changes on key areas such as observation, the Emergency Department, interventional radiology, and associated areas
  • Changes to and trends for the Provider-Based Rule (PBR) and the implementation of Section 603 of BiBA 2015
  • What changes and directions can you anticipate further for APCs?
  • Are rural SCHs and EACHs affected by the proposed changes?
  • What is all the fuss about status indicators?
  • Other payment mechanisms, such as cost outliers and co-payment amounts

Webinar Agenda

  • Review of APC final changes for CY2019
    • Coding/grouping changes
    • E&M coding
    • Recalibration of APC weights
    • Ongoing problem areas
    • Cost report changes – charge compression
    • Drugs and biologics
    • Cost outliers
    • Interventional radiology
    • Additional comprehensive APCs
    • Inpatient-only procedures
  • APC trends
    • Increased bundling and packaging
    • Comprehensive APCs
    • Shifts in realigning payments
    • Development of comprehensive APCs
    • Policy and interpretive changes
    • Impacts of CPT/HCPCS changes
  • Provider-based clinic changes
    • CMS information collection
    • BiBA 2015 – Section 603 implementation
    • Service lines and equalization of payment
    • Projecting the future for provider-based clinics
  • Associated proposed APC changes
    • Ambulatory surgery centers
    • Related physician changes
    • Clinical service area considerations
    • RAC audit concerns
  • Assessing the impact of proposed changes
    • Financial impacts
    • Coding and billing impacts
    • Other operational impacts
    • APC compliance issues
  • The future for APCs

Who Should Attend

  • Outpatient clinical staff
  • Nursing staff
  • ED nursing staff
  • Provider-based clinic nursing staff
  • Physicians
  • Outpatient departmental managers
  • Nurse auditors
  • Coding personnel
  • Coding, billing, and claims transaction personnel
  • Internal auditing personnel
  • Financial analysts
  • Revenue cycle specialists
  • Compliance personnel
  • Cost accounting personnel
  • Chargemaster coordinators
  • Cost reporting personnel

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker. 

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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
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