This week’s note is about coding, billing, and payment for skin substitute products. Click the link above for more information and an in-depth analysis.
In the Medicare Claims Processing Transmittal 2903, April 2014 Update of the Hospital Outpatient Prospective Payment System (OPPS), CMS discusses the current policy regarding billing for certain devices that are received by facilities at no cost, full credit, or partial credit.
In a concerted effort to move healthcare payments to a system of "quality over quantity," CMS finalized policies that greatly expanded packaging for outpatient providers in the 2015 OPPS final rule (www.gpo.gov/fdsys/pkg/FR-2014-11-10/pdf/2014-26146.pdf). It also introduced complexity adjustments with comprehensive ambulatory payment classifications (C-APCs).
Some hospital case managers may be breathing a small sigh of relief because a provision in the 2015 OPPS proposed rule would, if finalized, put an end to a burdensome physician inpatient certification requirement for most patients.
