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January 25, 2018

Four Tests Added to List of CLIA Waived Tests

In early January, the Centers for Medicare and Medicaid Services (CMS) announced new waived tests... Learn More

New and Revised Vaccine Codes Added to 2018 CPT Code Book

The American Medical Association (AMA) added and revised several vaccine CPT codes for its 201... Learn More

OIG Recommends Measures for Curbing Opioid Misuse and Fraud

Office of Inspector General testimony before the House Committee on Ways and Means in January ... Learn More

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Medical Coding News Archives

Outpatient Prospective Payment Rule Released

November 13, 2007:
The final rule on the outpatient prospective payment system describes new payment policies and quality measure reporting, and updates the rates for the revised ambulatory surgery center (ASC) payment system. The rule applies to services furnished during calendar year (CY) 2008.

Some of the issues addressed in the rule, released by the Centers for Medicare and Medicaid Services (CMS) on November 1, include:

Linking payment updates to quality measure reporting: Hospitals will be required to report seven consensus quality measures, including five emergency department acute myocardial infarction transfer measures and two surgical care improvement measures. Hospitals that are paid under the inpatient prospective payment system are required to report the applicable hospital outpatient quality measures to receive the full OPPS market basket update in CY 2009; otherwise, their CY 2009 update will be reduced by 2.0 percentage points.

Expanded packaging for CY 2008: The current packaging approach will be expanded to include guidance, image processing, and intraoperative services, imaging supervision, and interpretation services, diagnostic radiopharmaceuticals, contrast agents, and observation services.

Introduction of composite ambulatory payment classification (APC) groups: CMS is also adopting the use of composite APCs to “encourage efficiencies by providing one bundled payment for several major services.” According to CMS, composite APCs encourage even greater hospital efficiencies than expanding packaging by making a single payment for the totality of hospital outpatient care provided during an encounter.

Deborah C. Hall
Clinical/Technical Editor


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