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Proposed OPPS Rule Contains a Number of Policy Changes

on Thursday, 3 August 2017 in Health Law Alert: Erin E. Busch, Editor

On July 13, 2017, CMS issued the 2018 Proposed Rules governing the outpatient prospective payment system and ambulatory surgery prospective payment system.  The Proposed Rules include a number of proposed policy changes which are subject to comment until September 11, 2017.  A final rule is expected to be published on or about November 1, 2017.

In addition to the usual rate updates, the Proposed Rule includes:

Supervision of OP Therapeutic Services A key policy proposal to reinstate non-enforcement of the direct supervision requirement for outpatient therapeutic services performed in critical access hospitals and small rural hospital having fewer than 100 beds.  The proposal is to extend the current moratorium on enforcement for two more years once it expires on December 31, 2017.

340B Payment Rates A policy to reduce the payment rate under Medicare Part B beginning in 2018 for non-pass through drugs and biologicals acquired under the 340B Drug Pricing Program.

Lab 14-Day Rule  A request for comments on the “14 Day rule” related to the date of service for bills submitted for clinical laboratory tests. The purpose of the 14-day rule is to distinguish tests that may be billed by the performing laboratory from tests which must be billed by the hospital depending on the date the test was ordered by the patient’s physician.  According to the proposed rule, if the date of service for the test is within an inpatient stay or an outpatient encounter/stay, the payment is bundled with other hospital services and must be billed by the hospital.  Numerous problems were identified with application of the rule, prompting this request for comments to improve operational aspects.

Packaged Payments  Additional package payment proposals for hospital outpatient departments and ASCs. The package payment concept requires hospital outpatient departments and ASCs to roll charges for specified drugs into the procedure codes—deeming these to be supplies used in the procedure.  The policy has been viewed as having an adverse effect on patient care and access, consequently, CMS has proposed modifications that add a complexity adjustment to increase the payment for the code by initiating a new HCPCS code for certain procedures that use a drug.  On the ASC side, CMS is proposing an update to ASC payment rates and indicators to align ASC payment with the OPPS payment rates.

Julie A. Knutson


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