LogixHealth Releases Review of 2019 Outpatient Payment System Final Rule

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Feb 21, 2019, 08:45 ET

BEDFORD, Mass., Feb. 21, 2019 /PRNewswire/ -- LogixHealth has released its 2019 Outpatient Payment System (OPPS) Update, a review of the 2019 OPPS final rule published by the Centers for Medicare and Medicaid Services. The final rule establishes payment rates and policies for outpatient services furnished by hospitals that are paid under the OPPS, and governs services provided on or after January 1, 2019.

LogixHealth's 2019 Outpatient Payment System Update indicates that in 2019, CMS is updating OPPS rates by 1.35%. The change is based on the projected hospital market basket increase of 2.9% minus both a 0.8% adjustment for multi-factor productivity (MFP) and a 0.75% adjustment required by the Affordable Care Act. The unadjusted conversion factor under OPPS will increase from the 2018 OPPS conversion factor of $78.636 to $79.490 for 2019. After considering all other policy changes finalized under the OPPS, including estimated spending for pass-through payments, CMS estimates that total payments to OPPS providers will increase by approximately $360 million over CY 2018 (excluding changes in enrollment, utilization, and case-mix).

For 2019, the composite APC methodology continues to combine ED and observation services into a single APC. According to Elijah Berg, M.D., CEO of LogixHealth, the observation APC 8011 payment continues to increase. "In 2018, APC 8011 reimbursed $2,349.66, which will be increased to $2,386.80 for 2019. The observation APC underwent a drastic increase in payment in 2016 related to the extensive packaging associated with the Comprehensive APC construct," says Dr. Berg.

Each year, the OPPS final rule updates reimbursement rates for essential ED services. In particular, with the complex coding rules surrounding the high-frequency hydration, injection, and infusion codes, there is significant revenue at stake for these procedures. A table outlining the 2019 rates is included in LogixHealth's 2019 Outpatient Payment System Update.

For 2019, there are no significant changes to the rules governing ED facility E/M level guidelines. Per the initial description in the 2008 OPPS final rule, hospitals will be allowed to utilize their own scoring systems provided they accurately reflect facility resource utilization and are consistent with the 11 Guiding Principles published in the 2008 OPPS final rule.

LogixHealth's 2019 Outpatient Payment System Update and the CMS 2019 OPPS final rule, can be found on the LogixHealth website: www.logixhealth.com.

About LogixHealth:
LogixHealth provides expert coding and billing for top hospitals, emergency departments and office-based practices nationwide, servicing over 10 million patient visits annually across over 40 states. We provide tools and resources to optimize financial performance and improve the quality of care. For more information, visit www.logixhealth.com.

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