Health Information Management

Saying so long to 2012

APCs Insider, December 28, 2012

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The world did not come to an end last Friday, which gives us a chance to look back at 2012 and then turn our attention to 2013.

The change in the ICD-10 implementation date certainly ranks at or near the top of big news for 2012. HHS pushed the date back from October 1, 2013, to October 1, 2014. Look back at your implementation plan (you do have an implementation plan, right?) and assess where you are, determine where you should be, and create a plan to get when you need to be by October 1, 2014.
 
Remember that the conversion to ICD-10 isn’t just an HIM problem. The transition will affect just about everyone in a facility or practice, so make sure you look at every place ICD-9 codes live now. You’ll need to update all of those systems, forms, files.
 
On the bright side, you do have more time to accomplish your transition. Just don’t wait. You’re unlikely to get another reprieve, no matter how much the AMA complains.
 
Providers did score a big win in the OPPS final rule when CMS decided to revert to the statute and reimburse facilities at the same rate it reimburses physicians for separately payable drugs. However, that average sales price plus 6% still doesn’t cover the costs of acquiring, compounding, storing, and dispending drugs in a facility, but it’s a start.
 
CMS also changed the way it calculates reimbursement, moving to a geometric mean. The jury is still out on whether that will be a good change.
 
The AMA continues to combine services into single CPT codes, which means providers need to really look at how they develop charges. If you now use one CPT code to represent services that required multiple CPT codes in the past, be sure you’re charges reflect the work being performed.
 
We also saw the first changes to supervision requirements by the Hospital Outpatient Payment Panel. The panel held two meetings in 2012 and released long lists of codes that now require general supervision instead of direct supervision.
 
The panel’s work is ongoing, so if you think a service requires a different level of supervision, let them know.
 
On the subject of commenting, providers need to continue to comment on proposed rules. Tell CMS what you think (in polite, professional language). Sometimes it actually works. For example, CMS agreed with providers that HCPCS code G0379 (direct admission of patient for hospital observation) should be moved to APC 0608 (Level 5 hospital clinic visits).
 
So enjoy the last few days of 2012 and we’ll see you in 2013!
 
Michelle Leppert
Senior Managing Editor



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