Hospital Outpatient Prospective Payment System: 2017 APC Update

This presentation provides the audience with a better understanding of the significant changes associated with the 2017 Medicare Outpatient Prospective Payment System (OPPS) final rule published in early November 2016. Participants will be able to incorporate the information into plans for their hospitals as indicated by the changes.

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Learning objectives

  • Understand the changes impacting Medicare billing and reimbursement for hospital based clinic departments
  • Identify how these changes may impact future clinic payment
  • List the changes to comprehensive APCs and determine their effect
  • Know how the L1 modifier reporting has changed
  • Summarize the other major changes to hospital APC reporting and payment for 2017


Richard R. Cooley, BA, CCS – Partner, Epoch Health Solutions, LLC
Richard has more than thirteen years in healthcare consulting. He has developed an expertise in hospital outpatient and inpatient coding, including admission criteria reviews, billing, reimbursement, and compliance and charge master reviews. His areas of expertise include Medicare reimbursement for the Medicare Outpatient Prospective Payment System (OPPS) and Medicaid Ambulatory Payment Groups (APGs). He is a certified inpatient and outpatient coder with AHIMA. Richard earned his Bachelors from Hobart College, where he studied English and Chemistry.

Jean C. Russell, MS, RHIT – Partner, Epoch Health Solutions, LLC
Jean has over thirty years of healthcare and information system experience. Her areas of expertise include the Medicare outpatient prospective payment systems (APCs, and APGs), as well as ICD-10-CM/PCS training, Charge Description Master (CDM), admission status reviews, and outpatient coding and compliance. She is a frequent speaker at the national, state, and local levels for HFMA and AHIMA professional groups. Jean has her Masters from the University of Houston in Biomedical Engineering; her Bachelors from Colgate University in Biology; and her RHIT from the independent study program through the American Health Information Management Association. Jean is an AHIMA – approved ICD-10-CM/PCS Trainer.

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