Revenue Cycle

CMS shifts 2-midnight rule responsibility to QIOs, finalizes packaging expansion

Briefings on APCs, January 1, 2016

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Briefings on APCs.

CMS finalized nearly all of its proposals related to packaging in the 2016 OPPS final rule. It expanded packaging of labs from date of service to the claim level, except for existing and new molecular pathology services and all preventive lab tests.
 
CMS did finalize assignment of status indicator Q4 to all labs that are eligible to be packaged. This will allow automatic Clinical Laboratory Fee Schedule payment when labs are basically the only service billed on a claim and alleviates provider burden of appending modifier -L1 in these instances.
 
All CPT®/HCPCS codes assigned to Level 4 minor surgical procedures will be conditionally packaged (status indicator Q2). CPT/HCPCS codes assigned to Level 3 and 4 pathology service APCs will also be conditionally packaged (status indicator Q1).

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Briefings on APCs.

Most Popular