More News on the Horizon for OPPS Proposed Rules

Should all these proposals take effect next year, everyone is in for a huge shift in thinking for billing and reimbursement.

We have always encouraged reporting all chargeable procedures, supplies and medications that represent the full economic value of a patient’s encounter. This is not going to change; however, the reimbursements will should these proposed rules come into effect in 2014.

Seven new categories of packaged CPT codes are being proposed, moving to a DRG look-a –like environment. This will mean no separate payment for the CPT or HCPC codes in the 7 categories. Included in the proposal are Infusion additional hours, so a facility will only receive payment for the initial infusion. New Addendum P on the CMS website (www.cms.gov) lists all of the codes involved in CMS’s new packaging system; however these codes will be paid a separate payment if the code is reported alone on the claim.

CMS is proposing to replace existing device dependent APCs with 29 new comprehensive APCs; making a single payment when a primary procedure is on the claim and all other services would be packaged with no additional payment for the device. As mentioned previously the new status indicator J1 will be utilized to identify HCPCS that would be paid under the new comprehensive APC.

The comment period is now open, so now is the time to voice concerns about these proposals.

By Dawn Lodge RN, CPC
Charge Capture Educator


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