Outpatient Hospital Fee Schedule Payment Methodology Change

June 2017

Effective July 1, 2017 WSI will implement the use of the 3M Ambulatory Payment Classification (APC) grouper. The APC grouper will enable WSI to incorporate additional Medicare APC methodologies into outpatient hospital reimbursements, including:

  • Unconditional packaging
  • Conditional packaging
  • Composite APC packaging
  • Comprehensive APC packaging

WSI will begin processing bills utilizing the new APC grouper methodology for dates of service on or after July 1, 2017. To offset the impact of the increased APC payment packaging, WSI will provide a one-time increase of 6.28% to the Outpatient Hospital Fee Schedule conversion factor. As a result, the new conversion factor will be set to $142.10 for the remainder of 2017.

WSI will update the Outpatient Hospital Fee Schedule Guideline to include the new conversion factor, as well as new status indicators and payment parameters. The guideline will be available to coincide with the release of the APC grouper. A provider should refer to the revised guideline for complete information.

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