Health Information Management

Pay-Per-View: Wholesale OPPS packaging

APCs Insider, August 24, 2007

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On July 16, CMS released the 2008 OPPS proposed rule earlier than expected, and to the surprise of many, it did not propose national E/M coding guidelines. But CMS did propose changes that if made final, mark the first of many changes that will take the current prospective payment system to a more episode-encounter-based system, according to Jugna Shah, MPH, president of Nimitt Consulting in Washington D.C.

The rule proposes fundamental payment and policy changes that create more APC bundles through the use of expanded packaging proposals. "This is the most significant proposal of its kind that I can recall to date under OPPS, which could result in the biggest transformation for OPPS in terms of how providers set charges and bill their services and how CMS will (or will not) be able to use the maximum number of provider claims to set future payment rates," says Shah.

Click here to read more about the 2008 OPPS proposed rule from the September issue. Briefings on APCs subscribers have free access via their online subscriptions.

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