Highlights from the CMS July APC Update

The July APC update is out, and I’m sure many of you have already installed it and find the changes 3M made valuable for you.

With this update out, we now get to look ahead to 2014. This week CMS published the proposed rules for the Hospital Outpatient Prospective Payment for next year. There seem to be a number of notable changes coming up for hospitals in 2014. I would like to highlight a couple of them.

  1. Generally, we will see more aggressive packaging with:
  • Drugs and biological
  • Radiopharmaceuticals when used as in a diagnostic test or procedure
  • Diagnostic lab tests
  • Add-on codes
  • Ancillary services assigned a status indicator X
  • Diagnostic test on the bypass list
  • Procedures for removing a device

On average, we will see fewer separately payable line items per claim, although payable line items should be paid more.

  1. Medical visits will be significantly reworked reducing the complexity and effort need to maintain hospital specific guidelines for medical visit coding. Excluding composite APCs, this will result in reducing the number of medical visit APCs from 15 to 3. Another outcome may be to reduce exposure to RAC audits for medical visits.

Keep in mind that these are just the highlights from the update. There are other important changes in the rule that will impact your institution, so I urge each facility to be sure to read it and make certain you take time to perform an analysis of the impact to your facility. You can find the full update on the CMS website.

See you next time!

Dave Fee is the Outpatient Products Marketing Manager with 3M Health Information Systems.

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