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Anthem Blue Cross Commercial Outpatient Prospective Payment System

Hooper Lundy & Bookman has learned that Anthem Blue Cross is attempting to apply a Commercial Outpatient Prospective Payment System (COPPS) to commercial outpatient hospital services and is including provisions in amendments in its Facility Agreements to implement this program.

The COPPS claims to follow CMS OPPS logic in some, but not all, respects. HLB has reviewed the proposed amendments and has identified some issues with the proposed program and contract language. If you would like assistance with this matter or with review of your managed care contracts, please contact Daron Tooch in Los Angeles.

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