Health Information Management

Pay-per-view: CMS packaging clarification could raise problems

APCs Insider, January 11, 2013

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As part of the 2013 OPPS final rule, CMS finalized a clarification to 42 CFR 419.2(b) that could cause confusion in the future if hospitals are audited by third-party payers or by Medicare contractors who do not fully understand the intent of the language or how CMS develops payment rates, says Jugna Shah, MPH, president of Nimitt Consulting based in Washington, D.C.

In the 2013 OPPS final rule, CMS states it is clarifying:
the regulatory language at 42 CFR 419.2(b) to make explicit that the OPPS payments for the included costs of the nonexclusive list of items and services covered under the OPPS referred to in this paragraph are packaged into the payments for the related procedures or services with which such items and services are provided.
Continue readingCMS packaging clarification could raise problemson HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the January issue.

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