As providers work to implement policies and regulations introduced by CMS in the 2016 OPPS final rule, they should take some time before January 1 to make sure they’re ready to potentially report modifier –CT (computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association [NEMA] XR-29-2013 standard).
This week’s updates include: Claims processing Medicare Secondary Payer (MSP) policy and procedures regarding ongoing responsibility for medicals (ORM); Maintenance and update of the temporary hook created to hold OPPS claims that include certain drug HCPCS codes; and more!
CMS has sharply accelerated its push toward moving outpatient payments from a fee-for-service model to a true prospective payment system with a number of its proposals in the 2016 OPPS proposed rule (https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-16577.pdf), including new comprehensive APCs (C-APC) and extensive APC consolidation and reconfiguration.
The 2016 OPPS proposed rule released July 2 is deceptively short, but packs a punch. CMS is proposing the most massive APC reconfiguration and consolidation of APC groups since the beginning of OPPS, says Jugna Shah, MPH, president and founder of Nimitt Consulting, based in Washington, D.C., and Spicer, Minnesota.
To get a real sense of the financial impact, providers will need to take several steps, says Shah. First, review the narrative text to get a feel for the major categories of changes CMS is proposing, including some of the operational ones.
