In January, I wrote about the perfect storm that led to the release of the 2014 OPPS final rule.
We endured a later-than-usual release, errors in the data files and a release of updated files, a government shutdown, and a vastly shortened window between the release of the final rule and implementation on January 1. Judging by the confusion among providers?and corrections and clarifications coming from CMS on what seems like a weekly basis on a wide range of issues?we're still not in the clear.
Since January, providers have been struggling to reconcile conflicts between CMS' rules and regulations and those published by the CPT® Manual and other AMA publications.
Our experts answer questions on payment rates for scans, bronchodilator treatment, the inpatient-only list, stereotactic radiosurgery, bill exposure with arthrodesis, and more.
The CMS Innovation Center released a request for information (RFI) in February for input from specialty practitioners on new, episode-based payment models, which could signal a move toward even more bundled payments for outpatient procedures.
CMS has been making it clear over the years that packaging would become a larger and larger part of OPPS, and in calendar year (CY) 2014 CMS made good on this.
When an NCCI edit occurs on a claim, providers can go directly to CMS’ website and download the latest edits to pinpoint why the edit occurred and what codes may be conflicting.
Q Addendum B of the APC updates for 2012 indicates the new molecular pathology codes have status indicator E (noncovered service, not paid under OPPS). Our laboratory director said we should report these new codes in addition to the codes that are payable. Can you explain why?
