Health Information Management

Q&A: Why did payment rates for scans change in the OPPS final rule?

APCs Insider, February 7, 2014

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Q: We noticed a big difference in the APC national payment rates for some CT and MRI scans in the final Addendum B file when compared to the proposed rule file. We were glad to see the change, but did CMS miss that many claims in the original calculation?
A: CMS did not overlook data. Based on commenters' remarks, it took a second look at the data. Many providers still allocate costs for the new CT and MRI cost centers based on the square foot methodology. When this is used, the cost for the service gets spread across the entire hospital cost structure, rather than being concentrated in the actual area where it occurs.
After further review, and based on comments, CMS excluded the cost data from these new cost centers if the facility provider reports based on the square foot methodology. However, this is a limited reprieve. CMS stated in the final rule that it would begin using the cost data in these new cost centers in 2018, even if providers continue to report cost via this methodology. 
In the OPPS final rule, CMS noted, "the recommended changes are critical in the shared goal of developing OPPS relative payment weights that accurately reflect service costs." CMS also reminded providers that this was addressed in the IPPS final rule: "Hospitals that still need to correct their cost reporting practices in this regard should do so soon so that distinct CT and MRI cost center [cost-to-charge ratios] would accurately reflect the costs associated with providing those services."
Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

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