Health Information Management

APC panel spring meeting may hint at 2010 OPPS proposed rule

APCs Insider, March 6, 2009

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When the Advisory Panel on Ambulatory Payment Classification Groups panel (APC panel) holds its spring meeting, there are good reasons to pay attention. This year’s spring meeting took place in Baltimore, February 18-19.

“The important thing about [the spring APC] panel meeting is that the people who attend and the people who are presenting, get…an early preview of the types of things that Medicare is analyzing, “ says Jugna Shah, MPH, president of Nimitt Consulting, Inc. in Washington, DC. In turn, she says the subjects of CMS analysis offer a hint of what the agency may include in the proposed rule for 2010. The presenters and the audience also get a sense of what changes the APC panel itself is willing to recommend.

Of all the items on the APC panel agenda, Shah believes the most exciting is the likelihood that providers are finally going to see some relief on the contentious subject of separately payable drug APC reimbursement. The panel again recommends a set of clear changes that, if adopted by CMS, will finally stop and reverse the erosion we’ve seen for separately payable drug APC payments over the past several years, she says. For the first time, Shah says, the agency seems poised to embrace the recommendations made by the panel and echoed by the provider community as well as industry stakeholders.

Denise Williams, RN, CPC-H, director of revenue integrity services at Health Revenue Assurance Associates, Inc., Plantation, FL, agrees that movement on drug pricing, after two previous attempts by the presenting group of stakeholders, is the most exciting development to come out of the meeting. The change would be as good for CMS as it would be for providers, she says. “It helps them meet the statutory requirement for paying for pharmacy handling (also called overhead) separately from the payment for the acquisition cost of the drug.”

Among other activities, Williams notes a presentation that called CMS’ attention to the idea of expanding the present multiple imaging composites into more composites, based on the number of tests performed. Unfortunately, she says, the panel did not make any concrete recommendations to CMS on this, but did encourage the agency to study the proposal and its claims regarding multiple imaging composite APC payment rates and payment policy.

A detailed description of the APC panel is available on the CMS Web site. You can also download a zip file with the APC panel’s spring 2009 agenda and recommendations from this site.

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