OPPS Resource Center

Simplifying the OPPS Final Rule for the revenue cycle

Cloudmed’s government reimbursement experts are here to help you understand the Outpatient Prospective Payment System (OPPS) Final Rule updates that affect hospital outpatient and ambulatory surgery settings.

MEET OUR EXPERTS

OPPS Highlights + Memo

Our government experts have reviewed the 2023 OPPS Final Rule and identified the major updates that impact your business. Download the memo now and watch our webinar to learn what updates affect your organization.

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Highlights from 2023 OPPS Final Rule

Our government reimbursement experts summarized the major OPPS updates that go into effect on January 1, 2023.

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CMS OPPS Memorandum Calendar Year 2023

View the extensive OPPS summarized report our claim-level reimbursement experts created for revenue cycle leaders.

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Access the historical CMS report we’ve analyzed

Watch Our Presentations

2023 OPPS Final Rule Webinar

Learn about the top highlights from the 2023 OPPS Final Rule, as well as key updates from Washington that impact hospital outpatient and ambulatory surgery care settings.

WATCH ON DEMAND

Our Team of Experts

We are honored to have a distinguished group of reimbursement experts who come with years of experience and revenue cycle heritage in helping our providers navigate the ever-evolving healthcare landscape.

Claim Level Reimbursement Expert

Stacey Rivera

Stacey Rivera is Senior Director over the Medicare Review Team at Cloudmed. She has over 20 years of experience monitoring Medicare regulations, policy, and reimbursement issues and how various changes impact both hospital revenue cycle operations and claims-level reimbursement. Stacey also oversees a team of specialized auditors and coders responsible for identifying and resolving Medicare coverage, coding, billing, and payment issues for Cloudmed clients.

Claim Level Reimbursement Expert

Erika Via Gordon

Erika is the Director of Medicare Review at Cloudmed and hasoverseen a variety of Comprehensive Payment Review engagements for hospitals across the country and currently specializes in Medicare hospital reimbursement and regulations. She is a certified inpatient and outpatient coder and is one of the company’s experts on ICD-10 and general billing and coding guidelines.

Claim Level Reimbursement Expert

Bryn Woodward, COC, Director of Medicare Review

Bryn Woodward, COC is a Director on the Medicare Review Team and has been consulting with hospital clients across the US for over thirteen years. Bryn specializes in Medicare IPPS and OPPS reimbursement for the last seven years and leads a team of coders and reimbursement auditors who identify and validate underpaid claims due to billing, coding, and coverage issues. In addition, as a Medicare subject matter expert, she provides insight on questions ranging from OPPS pricing logic, MAC claims processing rules, NCD/LCD issues and more.

Claim Level Reimbursement Expert

Simone Smallwood, Manager of Pharmaceutical Review

Simone graduated cum laude from Duke University concentrating on Health Policy with majors in Public Policy and Global Health. She has been with Cloudmed for 5 years, during which time she has served on the Hospital Billing Underpayments Team, Medicare Review Team, Pharmaceutical Review Team, and Charge Capture Review Team. Since 2019, Simone has collaborated on creating client deliverables summarizing the IPPS and OPPS Final Rules.

Cost Reporting Expert

Julie DiFrancesco, EVP of Government Navigation Suite

Julie comes with over 32 years of experience in the health care industry and more than 27 years working specifically in reimbursement. Julie manages all Medicare Reimbursement services, including Medicare Bad Debt, Disproportionate Share and Uncompensated Care (S-10). She has been a national speaker on many topics related to Medicare reimbursement and taught a Medicare cost report class nationally for the Healthcare Financial Management Association (HFMA) for nine years bringing tremendous insight and expertise for hospital providers.

Cost Reporting Expert

Emily Auten, VP of Government Navigation Suite

Emily has over 20 years of experience in the healthcare industry. She started her career as an auditor for a Medicare Administrative Contractor (MAC) and then continued on for 12 years at a large firm, where she developed extensive knowledge of the cost report and specialized in Medicare Reimbursement services such as Wage Index, DSH and MBD. Emily specializes and leads the Medicare Bad Debt and S-10 service lines.rn

Cost Reporting Expert

Ed Kelly, SVP of Government Navigation Suite, DSH

Ed has over 17 years in the healthcare industry focused mostly on Medicare DSH and working for large consulting firms like Deloitte and Ernst u0026 Young. Ed serves as the leader of Medicare Disproportionate Share (DSH) services aimed at various hospitals and health systems across the country. He enjoys training new and experienced hires and even worked a short stint at a Nano-Learning company.

Cost Reporting Expert

Becky Brugler, SVP of Government Navigation Suite

Becky Brugler has been in the health care industry for over 40 years, including eight years at the FI/MAC, sixteen years at healthcare systems in Reimbursement, and fifteen years in Regulatory consulting, working at 3 of the top 5 accounting firms in the country. Becky specializes in Medicare DSH reimbursement, Medicare/Medicaid/TriCare Cost Reporting, Third Party Payments and Settlements, Medicare Wage Index, SSI Recalculations and Medicare Outlier Reconciliation.

Cost Reporting Expert

Larry Millner, Ph.D., Director of Medicare Reimbursement

Larry earned a Ph.D. in Health Care Administration and has worked as a senior leader in health care over 60 years as a VP and consultant for large not-for profit health systems. He specializes in Medicare DSH reimbursement, Uncompensated Care/Worksheet S-10, 340B Discount Drug Pricing program and reimbursement impacts to hospitals with the Affordable Care Act.

Cost Reporting Expert

Guy Patterson, Director of Medicare Reimbursement

Guy has worked in senior management over the past 35 years with both private and public health care companies, including consulting roles with some of the largest healthcare entities around the country. Guy specializes in hospital reimbursement with a concentration on Medicare Disproportionate Share, Medicare Bad Debt, Uncompensated Care/Worksheet S-10 and 340B Discount Drug Pricing Program. His specialty has concentrated on using hospital data analytics to document and drive additional reimbursement for large healthcare systems.

Meet with our experts

Our cost report and claim reimbursement experts are available for your regulatory needs and questions

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