Health Information Management

Providers should comment on the 2006 OPPS proposed rule

APCs Insider, September 1, 2005

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Providers should comment on the 2006 OPPS proposed rule

QUESTION: The 2006 APC fee schedule is available on the Internet, but it is a proposed fee schedule. We hear that the APC rates are effective beginning in October 2005. Knowing that DRG payments take effect October 1, are the new APC rates also effective October 1?

ANSWER: The effective date for APCs is January 1 of each year, not October 1. You can find the 2006 OPPS proposed rule on the CMS Web site: The rule was also published in the July 25 Federal Register.

CMS is accepting public comment on the proposed rule until September 16, 2005. Once it receives and reviews these comments, Medicare will finalize the 2006 OPPS rule sometime in late October or early November 2005. The Final Rule will be available in the Federal Register and on the CMS Web site. The rule will contain addendums for national payment rates as well as operational changes that may impact your facility. All changes in the Final Rule take effect January 1, 2006.

Highlights of the 2006 proposed rule include the following:

  • Substantial changes to how providers code and bill observation
  • Discounting of diagnostic imaging for multiple procedures in specific family sets
  • New C codes for pharmacy handling/overhead costs
  • New 2006 CPT codes for drug administration (chemotherapy and nonchemotherapy infusions and injections)
  • Discounting of procedures appended with modifiers -52, -73 and -74

It is extremely important that a representative(s) from your facility reads the proposed rule, submits comments where appropriate, and implements a plan to educate staff about the changes that have the greatest impact on your facility's operational and charging processes.

Note that it is easier than ever to submit comments to CMS because you can now submit them electronically. The first pages of the proposed rule explain how you can do this.

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