This week’s Medicare updates include the Outpatient Prospective Payment System proposed rule, a video on the proposed changes to evaluation and management coding, the July edition of the Patients Over Paperwork newsletter, and more!
Back in January, I wrote an article regarding E/M codes and the need for changes to the 1995 and 1997 E/M documentation guidelines. In that article, I suggested making E/M codes for office visits solely time-based to simplify the reporting of these very subjective codes. Little did I know that this is what CMS would propose months later.
CMS did not propose any new comprehensive APCs (C-APC) last year, taking a rare year off, but it did introduced three new C-APCs in the 2019 OPPS proposed rule, released in late July.
CMS’ 2019 OPPS proposed rule continues the agency’s efforts to enforce site-neutral payments and reduce drug payments by introducing policies to reduce reimbursement for hospital outpatient clinic visits at off-campus, provider-based departments (PBD) and expanding last year’s payment reductions for drugs purchased under the 340B discount pricing program by nonexcepted PBDs.
Integrating facility and professional fee coding into one centralized department model can help organizations make the most of advances in technology and manage costs.
CMS would use the proposed modifiers to implement a 15% payment reduction starting in 2022 for services provided in whole or in part by physical therapy assistants (PTA) and occupational therapy assistants (OTA).
