Action required: Conversion to a new reimbursement system for outpatient facility services

Empire BlueCross BlueShield (“Empire”) is in the process of converting to a new reimbursement system called Commercial Outpatient Pricing Payment System (COPPS). We will be converting outpatient facility services to the system throughout 2022 and 2023 followed by all other contracted providers shortly thereafter. Make sure you avoid payment disruptions by converting to COPPS prior to us replacing the current system.

 

COPPS is heavily based on the CMS Outpatient Prospective Payment System (OPPS) and is the preferred commercial reimbursement system for hospitals and Ambulatory Surgery Center outpatient services. Therefore, moving to COPPS will keep our reimbursement system consistent with industry standards, allowing for greater efficiencies and more accurate and predictable pricing of outpatient services.

 

Other benefits of COPPS:

• Hospitals are already familiar with OPPS based reimbursement under Medicare, on which COPPS is based
• COPPS reimbursement more accurately reflects the resources used based on industry standards
• COPPS reimbursement eliminates an outdated Empire-specific system and promotes more consistent billing on outpatient services
• Hospitals will notice a decrease in audit activities under COPPS reimbursement

To ensure you have a seamless transition to COPPS, we’re taking a phased, multi-year approach that includes collaboration, education, and data transparency. Your Empire Contract Management Lead will soon begin discussions with you on COPPS conversion and what you need to know.

 

2181-0522-PN-NY