Modified and Corrected OPPS Rule Released By CMS

The Centers for Medicare & Medicaid Services (CMS) has corrected the technical errors that appeared in the 2012 Outpatient Prospective Payment System (OPPS) final rule. The corrections document revises language, adds and deletes services, and brings changes to Tables 19 and 59. Corrections went in to effect on January 1, 2012.

CMS says that the organization mistook in including some line items that were worthy of payment but were rejected during claims processing as they did not meet Medicare’s eligibility for payment. Median costs used to make payment have been affected by this.

Corrections have thus been made to programming logic in the OPPS data and the median cost has been recalculated. Owing to the recalculated costs, the APCs now displays violations of the two times rule, which caused the following APC codes to be added:

• APC 0105 Repair/revision/removal of pacemakers, AICDs, and vascular access devices

• APC 0263 Level 1 miscellaneous radiology procedures

• APC 0655 Insertion /replacement/conversion of a permanent dual chamber pacing electrode

In addition, several APCs now no longer display violations of the two times rule. Following APSC codes have now been removed:

• APC 0262 Plain Film of Teeth

• APC 0341 Skin Tests

• APC 0660 Level II Otorhynolaryngologic Function Tests

Revisions are also being made to Table 19 (Final APC Exceptions to the 2 Times Rule for CY 2012 (76 FR 74227and to reflect these changes. In addition, Table 59 – Estimated Impact of the Final CY 2012 Changes for the Hospital Outpatient Prospective Payments System (76 FR 74562) and the correlating preamble language (76 FR 74570) has also been revised.

Read more about this at http://www.ofr.gov/OFRUpload/OFRData/2011-33751_PI.pdf.