Health Information Management

Provider comments might provide insight into CMS’ imminent OPPS final rule

APCs Insider, October 24, 2014

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By Steven Andrews, Editor
 
Unlike last year, when the release of the OPPS final rule was marred by incorrect data files, an extended comment period, and a government shutdown, we can reasonably expect this year's rule to appear on time in approximately one week.
 
While we don't yet know which parts of the 2015 OPPS proposed rule CMS will finalize, we can get insight into what providers are hoping for by looking at the comments they submitted electronically at regulations.gov.
 
CMS reviews each of the comments and will often quote or reply to them in the final rule, so providers are always encouraged to send them in.  
 
"It's important for providers to weigh in on the proposed changes, especially ones that might create administrative or operational burden," says Jugna Shah, MPH, president and founder of Nimitt Consulting.
 
The first interesting insight on the site is the number of comments submitted for the proposed rule. The number doesn’t include every comment CMS received—it also accepts comments via mail and hand-delivery—but it's probably a good barometer of the overall volume. 
 
For the 2015 proposed rule, CMS received approximately 600 submissions online, compared to more than 1,500 last year. For the 2013 and 2012 proposed rules, CMS received approximately 600 and 1,100 electronic submissions, respectively.
 
This seems to indicate that providers did not feel particularly strongly about the proposed changes this year. This makes a certain amount of sense, since the 2014 proposed rule introduced Comprehensive APCs and also proposed collapsing E/M levels.
 
Since CMS stated in the 2014 OPPS final rule that it would modify and reintroduce Comprehensive APCs the following year, they weren't much of a surprise to providers, who had a year to begin planning for how to deal with them operationally.
 
But that doesn't mean providers approve of all of CMS' proposals. Out of the dozens of comments I read, I couldn't find any that supported CMS' method for tracking a new HCPCS modifier for physician and outpatient hospital services furnished in off-campus provider-based departments. CMS wants the modifier to be included on all CMS-1500 claim forms and UB-04 forms reporting these services, starting January 1, 2015.
 
While providers agree this data can be useful, they've so far resisted all of the methods CMS has suggested for collecting it. However, considering CMS has asked for comments specifically on this topic before, it will be interesting to see if CMS sides with commenters and finds a less burdensome approach or pushes through with its current proposal.
 
In previous rules, CMS has used the excuse that providers haven't suggested proper alternatives, so even though it may acknowledge resistance to its process for applying the modifier, that doesn't mean CMS won't implement it.



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