Health Information Management

Tip of the Week: Stay up-to-date with packaging changes outlined in the OPPS final rule for 2008

APCs Insider, November 9, 2007

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In addition to finalizing most of its proposals, CMS created a new type of APC (a composite APC, which enables the use of more multiple claims data and enables the payment system to better reflect how services are commonly furnished) in its 2008 OPPS final rule (CMS-1392-FC) released Thursday, November 1. The rule takes effect on January 1, 2008.

Note that CMS is also moving forward with expanded packaging in each of the following categories:

  • Guidance services
  • Image processing services
  • Intraoperative services
  • Imaging supervision and interpretation services
  • Diagnostic radiopharmaceuticals
  • Contrast media

By expanding its packaging logic, CMS will no longer pay hospitals separately in 2008 for a large number of services for which hospitals currently receive separate payment. "I'm definitely surprised at how much of a hard line CMS has taken given all of the comments, including the recommendations from the APC Advisory Panel," says Jugna Shah, MPH, president of Nimitt Consulting in Washington, DC.

You can find a complete list of all packaged HCPCS codes in Table 10 on p. 313 of the OPPS final rule. This table indicates whether a code has a status indicator of "N" (packaged services) or "Q" (packaged services which are subject to separate payment under certain OPPS payment criteria). Also note that radiology imaging and guidance is a major packaging item. To view the final rule, click here.

To view the e-blast, click here.

(The above tip appeared in an e-blast sponsored by Briefings on APCs).

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