Every year we make a plan to ensure our preparedness for the Outpatient Prospective Payment Systems (OPPS) impact…unfortunately, daily operations and multiple intersecting priorities replace good intent!  And each year January 1^st quickly approaches, and healthcare organizations across the country struggle to update their workflows to accommodate the yearly changes.  This year’s 2018 Hospital OPPS Final Rule was published November 13, 2017, leaving little time to prepare. Although changes to status indicators, APCs and CPTs are substantially less burdensome compared to previous years, it is important to understand how these changes can affect your organization’s resources and associated workflows.

Certainly, this is not a new struggle for health systems, but the opportunity to analyze and understand the impact can often fall to the bottom of the priority list.  As the growing pressures of decreased reimbursement and increased resource focus on quality expand, healthcare facilities have indicated they do not have the bandwidth to allocate resources to the project analysis.  Where do you start or at least get the most out of a high-level assessment of impact if you have not already done so?

Industry leading practice recommends getting a jump start on analysis when the proposed OPPS rule is published in July, allowing ample time for review and process planning. The analysis could be as simple as utilizing your internal grouper software compared to the proposed addendum B. This will provide precision on the impact for services rendered at your facility.  For example, there may be drugs that will be separately payable which means potential increased medical necessity edits.  The great news is it’s not too late to start now!   Data is rich in healthcare systems and you can get started on this analysis with claim level data and a comprehensive understanding of the throughput of your revenue cycle. This analysis should assist you in determining the resource impact, identifying required education, outlining system changes/edits, and alerting senior leadership of potential impact to your current revenue cycle metrics.

Wilshire is encouraging you…. don’t delay and wonder what the impact will be.  Feel good about a resolution that you can keep!  The Wilshire Group is wishing you a Happy New Year filled with resolutions yielding much success in 2018!

We’re here to help!