Change to Outpatient Payment Method - (Outpatient Prospective Payment System - OPPS)

Office of Workers' Compensation Programs (OWCP)

(Note: the Division of Energy Employee Occupational Illness Compensation (DEEOIC) Programs implementation of OPPS will be delayed until February 22, 2015)

Effective October 1, 2014, the following Office of Workers' Compensation Programs (OWCP), Division of Federal Employees Compensation (DFEC), will implement a new reimbursement methodology which will be based on the Medicare Outpatient Prospective Payment System (OPPS). The payment method will utilize Medicare's Ambulatory Payment Classifications (APC) as well as the OWCP Fee Schedule. Outpatient bills submitted with a date of service before October 1, 2014, will be priced based on the OWCP Fee Schedule. Outpatient bills submitted with a date of service on or after October 1, 2014 will be priced based on the APC rate and/or OWCP Fee Schedule. The new method will apply to outpatient care in all acute care hospitals, including general hospitals, freestanding rehabilitation hospitals and long-term care hospitals, with the exception of Critical Access Hospitals and Maryland Hospitals. When submitting an OWCP-04 form for Outpatient services, providers will be required to enter their Medicare Number in box 51. If the Medicare Number is missing or invalid, the bill will be denied.