Health Information Management

E/M guidelines not expected until 2005

APCs Insider, November 7, 2003

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CMS releases final rule on OPPS payment increase; E/M guidelines not expected until 2005

CMS announced a final rule updating and increasing outpatient prospective payment system (OPPS) payment rates. The rule increases aggregate payments to outpatient departments by 4.5% and increases payments for some preventive health services.

CMS says not to expect final facility level E/M guidelines before January 2005. CMS will provide least six to 12 months notice before implementing facility E/M codes and guidelines.

The final rule also says that hospitals will not be required to use HCPCS codes when billing packaged drugs, but they will need to continue using revenue code 636 when reporting separately payable drugs. CMS also reinstated the category device C-codes, but it is up to providers to decide whether to use them.

CMS did not reduce the payment rates for blood and blood products by 10% or more as originally proposed. The rule also dropped the median cost threshold for packaged drugs and radiopharmaceuticals with median costs to only $50 per day, which means more will be separately payable in 2004.

The final rule will be published in the November 7th Federal Register and will go into effect on January 1, 2004. For more info click here.

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