2018 OPPS Proposed Rule: Breaking Down Financial and Organizational Impacts

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2018 OPPS Proposed Rule: Breaking Down Financial and Organizational Impacts - On-Demand

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2018 OPPS Proposed Rule: Breaking Down Financial and Organizational Impacts

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Available ON-DEMAND

Presented on:
Tuesday, August 15, 2017

Presented by:
Jugna Shah, MPH
Valerie A. Rinkle, MPA

Level of Program:

The 2018 OPPS proposed rule may be one of the shortest in recent memory, but it includes several significant proposals that could have a major financial and administrative impact on hospitals. In order to provide the most useful feedback to CMS and prepare for potential changes in the final rule, hospitals will need to learn about the provisions in the proposed rule.

During this 2-hour on-demand program, expert speakers Jugna Shah, MPH, and Valerie A. Rinkle, MPA, will analyze the proposed rule and deliver a comprehensive program to update providers on the major changes proposed for 2018, including reducing payment for drugs purchased under the 340B drug discount program, expanded packaging that includes drug administration for the first time, and new potential modifiers.

Shah and Rinkle will also review important proposals described in the Medicare Physician Fee Schedule (MPFS) proposed rule that impact outpatient hospital services, including updated payment policies for non-excepted, off-campus outpatient departments. Other proposed changes to be discussed include the inpatient-only list, skin substitute packaging, and reporting of certain clinical diagnostic laboratory tests.

At the conclusion of this program, participants will be able to:

  • Describe proposed changes to the 340B drug discount program and an associated new modifier
  • Explain the impact of proposed packaging of low-level drug administration services
  • Understand continued payment policies applicable to non-excepted, off-campus provider-based departments
  • Determine the financial impact and application of CMS’ proposed modifier to identify certain imaging services
  • Comment on proposals for which CMS is specifically seeking input, including reducing administrative burden, 340B program changes, and drug administration add-on code payments


  • Payment reductions for the 340B drug discount program
    • Drugs excepted from this policy
    • CMS’ proposed modifier to identify drugs that are not part of the program
  • Supervision of hospital outpatient therapeutic services
    • Reinstatement of direct supervision enforcement moratorium
  • Packaging policies
    • Addition of low-level drug administration services
    • Increased drug packaging threshold
    • CMS’ call for comments on existing packaging policies
  • Billing and payment for laboratory services
    • Modifications to current date of service policy
    • CMS’ solicitation of comments on changes
  • Major policies proposed in the MPFS that impact outpatient hospital services
    • Non-excepted, off-campus provider-based department payment
    • Appropriate use criteria
    • Medicare Diabetes Prevention Program
  • Other key changes related to charging, coding, and billing outpatient services
    • Inpatient-only list updates
    • Chronic care management codes
    • New APC for imaging without contrast
    • Status indicator changes

Who Should Listen?

  • HIM directors and staff 
  • Outpatient coding managers and staff 
  • Billing managers and staff 
  • Revenue cycle professionals 
  • Chargemaster coordinators 
  • Auditors 
  • APC coordinators 
  • Compliance officers 
  • Finance team members 
  • Revenue integrity professionals 

Continuing Education

(Live + On Demand) - This program has the prior approval of AAPC for 2.0 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. (Ability to claim CEUs for this webinar expires on: 8/14/18)

American Health Information Management Association (AHIMA)
(Live + On Demand) - This program has been approved for 2.0 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor. (Ability to claim CEUs for this webinar expires on: 8/14/18)

Meet the Speakers

Jugna Shah, MPH
Jugna Shah, MPH,
is the president and founder of Nimitt Consulting, Inc., a firm specializing in case-mix payment system design, development, and implementation. She has extensive experience working with providers on the ongoing clinical, operational, and financial implications of Medicare’s OPPS based on APCs. She has educated and audited numerous hospitals on their drug administration coding and billing practices. She has contributed to several books and numerous OPPS/APC articles over the past 13 years. She is also a contributing editor of HCPro’s Briefings on APCs.

Valerie A. Rinkle, MPA
Valerie A. Rinkle, MPA,
is a lead regulatory specialist and an instructor for HCPro’s Medicare Boot Camp®—Revenue Integrity and Chargemaster Version, Medicare Boot Camp®—Utilization Review Version, and Medicare Boot Camp®—Hospital Version. Rinkle is a former hospital revenue cycle director and has over 30 years in the healthcare industry, including over 12 years of consulting experience in which she has spoken and advised on effective operational solutions for compliance with Medicare coverage, payment, and coding regulations. 

Webinar system requirements and program materials: 

To fully benefit from the webinar experience, please note you will need a computer equipped with the following: 

Browser: Microsoft Internet Explorer 6 or later, Firefox, Chrome, or Safari, with JavaScript enabled 
Internet: 56K or faster Internet connection (high-speed connection recommended) 
Streaming: for audio/video streaming, Adobe Flash plug-in or Safari browser on iOS devices 

Prior to the webinar, you will receive an email with detailed system requirements, your login information, presentation slides, and other materials that you can print and distribute to all attendees at your location. 

No problem. The On-Demand version is now available. Use it as a training tool at your convenience—whenever your new or existing staff need a refresher or need to understand a new concept. Play it once or dozens of times. A $259 value! 

Participation in the webinar is just $259 per site. All materials must be retrieved from the Internet. 

Call your customer service representative toll-free 800-650-6787 or email customerservice@hcpro.com if you have questions.