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Final OPPS Rule Increases Drug Payments

HealthLeaders Media Staff, for HealthLeaders Media, November 5, 2012

The 2013 Outpatient Prospective Payment System final rule finalizes ambulatory payment classification system changes, but hospitals will need to read the Medicare Physician Fee Schedule Final Rule to find some of the biggest operational changes facing them next year.

The Centers for Medicare & Medicaid Services released the 2013 OPPS Final Rule on November 1.

"For the last several years the provider community has had to read both rules to find all of the changes that impact hospitals," says Jugna Shah, MPH, president of Nimitt Consulting based in Washington, DC. "This might seem unintuitive, but CMS addresses issues in whichever rule it uses to make the payment and since (always) therapy services are paid under the Physician Fee Schedule, that's where hospitals will have to look to understand the new rules they will be expected to abide by in 2013."

Therapy services

Therapy departments need to digest the rules carefully to comply with new HCPCS G-codes and complexity/severity modifiers and to provide complete documentation for services provided.

CMS is required by law to implement a claims-based data collection strategy for therapy services for information about:

  • beneficiary function and condition
  • therapy services furnished
  • outcomes achieved

Medicare expects to use this information in reforming the payment system for outpatient therapy services in the future.

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