Health Information Management

Pay-per-view: CMS proposes massive APC reconfiguration, updates 2-midnight rule

APCs Insider, September 11, 2015

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The 2016 OPPS proposed rule released July 2 is deceptively short, but packs a punch. CMS is proposing the most massive APC reconfiguration and consolidation of APC groups since the beginning of OPPS, says Jugna Shah, MPH, president and founder of Nimitt Consulting, based in Washington, D.C., and Spicer, Minnesota.
To get a real sense of the financial impact, providers will need to take several steps, says Shah. First, review the narrative text to get a feel for the major categories of changes CMS is proposing, including some of the operational ones.
Second, this year's rule includes many changes that aren't obvious from the narrative text. Providers will need to review the proposed rule's Addendum B to see if status indicators are changing for their top 25-50 billed services, according to Shah.
Third, to get a handle on financial impact, providers will once again need to move beyond line item payment rate comparisons and begin analyzing entire claims to see whether they will face financial impact and to what extent, says Shah.
Continue reading "CMS proposes massive APC reconfiguration, updates 2-midnight rule" on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the September issue.

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