• E-mail
• Print
• RSS

CMS updates manuals for OPPS 2009 payment policies

Medicare Weekly Update, January 6, 2009

Want to receive articles like this one in your inbox? Subscribe to Medicare Weekly Update!

While most everyone else was on vacation last week, CMS released two very significant transmittals relating to the hospital outpatient prospective payment system (OPPS). In general, the transmittals “manualize” regulatory changes and interpretative guidance from the 2009 OPPS final rule.

The first transmittal updates various CMS manual section relating to Medicare coverage of hospital outpatient services. The changes to the Medicare Benefit Policy Manual, Chapter 6 § 20.5.1 will be of particular interest to many hospitals. Section 20.5.1 addresses the conditions of coverage for hospital therapeutic services under Medicare’s so-called “incident to” benefit. As usual, the changes are somewhat difficult to decipher. It appears, however, that CMS is attempting to clarify that while a non-physician practitioner may order therapeutic hospital services (within the scope of his or her practice), only a physician or clinical psychologist may furnish the direct supervision required for Medicare to cover such services. It also appears that CMS is attempting to clarify (as CMS suggested in the 2009 OPPS final rule) that the physician or psychologist furnishing the direct supervision must be physically present in the “department.” Unfortunately; however, the revised manual section does not define the word “department.”

The second transmittal addresses numerous changes to CMS billing requirements and payment policy for hospital outpatient services. Hospitals should also review that transmittal carefully as many of the changes will require an operational response. Be prepared to spend some time. The transmittal is 127 pages long.

Want to receive articles like this one in your inbox? Subscribe to Medicare Weekly Update!

• Comment
• E-mail to a Colleague
• Print
• RSS
• Archive

Comments