Health Information Management

Q/A: Additional OPPS changes for 2011

APCs Insider, January 14, 2011

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Q: We have read the final OPPS 2011 rules. However, between publication of the rule and the beginning of the new year, additional changes typically are made. Did this occur for 2011l? If so, please explain.

A: CMS published the final 2011 OPPS Rule (CMS-1504-FC) November 24, 2010. President Obama then signed the Medicare and Medicaid Extenders Act of 2010 (MMEA) into law December 15.
The following is a summary of MMEA’s key provisions and information about how these changes may affect providers and provider billing, especially with respect to outpatient encounters.

Section 108 of MMEA now extends the outpatient hold harmless provision to rural hospitals with 100 or fewer beds and to all sole community hospitals and essential access community hospitals regardless of bed size through December 31, 2011. This is effective for dates of service on and after January 1, 2011.

Also, the Multiple Procedure Payment Reduction (MPPR) for Selected Therapy Services (MM7050) was revised. MPPR is a component of the Medicare Physician Fee Schedule Final Rule for 2011 (CMS-1503-FC). Transmittal CR 7050, was revised based on policy changes required by the Physician Payment and Therapy Relief Act of 2010. The statute changed the multiple payment procedure reduction for therapy services in the office setting or a non-institutional setting from 25% to 20%. The reduction remains at 25% for institutional settings, including hospital outpatient departments. CMS also revised the change request release date, transmittal number, and Web address for accessing CR 7050. Editor’s note:

Andrea Clark, RHIA, CCS, CPCH, president of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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