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Acknowledging comments received from providers regarding policies in the 2016 OPPS proposed rule, CMS is proposing for 2017 that procedures with a HCPCS code-level device offset of more than 40% of the APC costs would be designated as device-intensive procedures and subject to those applicable payment policies.
This week’s updates include a notice of proposed rulemaking for bundled payment models for high-quality, coordinated cardiac and hip fracture care; FY 2017 rate update for inpatient psychiatric facilities PPS; and more!
In the 2017 OPPS proposed rule, CMS is proposing to continue its comprehensive APC (C-APC) policy first implemented in 2015 and has proposed 25 new C-APCs for 2017 in addition to the existing 37 C-APCs.
If a Medicare patient is downgraded from inpatient to observation is it expected that the patient will be issued the MOON and condition code 44 will be used on the claim?
Modifier -58 describes a staged or related procedure or service by the same provider during the postoperative period. For outpatient hospitals, the postoperative period is defined as the same service date.
Healthcare organizations have become mass gatherers of data. But without sophisticated analytics, integrated IT tools, and processes to mine that data, they may not be able to take advantage of it.
CMS' Transmittal 3523, issued May 13, is the quarterly July 1 OPPS update. In this transmittal, CMS briefly mentions billing physical and occupational therapy and speech-language pathology services provided in support of or adjunctive to comprehensive APC (C-APC) services under revenue code 0940 (general therapeutic services) rather than the National Uniform Billing Committee‑defined revenue codes for these services (i.e., 042x, 043x, and 044x, respectively).
