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Proposed OPPS Rule Holds Significant Changes

Michelle A. Leppert, for HealthLeaders Media, July 10, 2012

However, other APC payments drop significantly. Fox example, the proposed APC payment rates for CPT codes assigned to APC 139 could decrease by 31.4%, Shah says. A detailed review of CMS' proposal is required and as always providers should provide comments to CMS.

Separately payable drugs
For CY 2013, CMS proposes to reimburse hospitals for separately payable drugs and biologicals without pass-through status at average sales price (ASP) plus 6%, a 2% increase from 2012.

"I am very excited about this," Shah says. "We have been trying to get CMS to make this change for years, and now the agency has finally included this in its proposed rule." CMS' proposal for 2013 would finally result in payment parity for separately payable drugs in the physician office setting, which is something that providers have been pushing the agency to do. CMS is able to provide payment at the level of ASP +6% by statute if it believes that it does not have average acquisition cost data for separately payable drugs, and though the agency hasn't relied on this argument or the statute in the past, it appears to be doing so for 2013.

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