Tag Archives: OPPS

Comprehensive APCs: 4 Steps for Review

It’s already two months into 2015 and I can’t help but think of the changes coming to the outpatient prospective payment system (OPPS) and APCs. CMS introduced APCs and OPPS in 2000. Since then, they have been working to slowly increase packaging within the system.

In 2014, significant increases in packaging were introduced. This year, they have continued to make major changes that will have an impact on every hospital that is subject to the Medicare OPPS and APCs. I am specifically thinking about: Continue reading

OPPS Proposed Rules: Implications of the Government Shutdown

Well, the federal government is back to work after two and a half weeks off. I will refrain from any political comments. However, I would like to discuss the implications it might have on the OPPS changes for 2014.

All comments on the proposed rule were due about the middle of September. Normally CMS would have six to eight weeks to review the comments and publish the final rule on November 1st. However, with the government shutdown, there is not going to be anywhere close to six weeks, let alone eight weeks, to review the comments and publish a final rule.

Our government teams are back, and now the question: What is going to happen with the final rule? Continue reading

Setting the Record Straight on Therapy Functional Reporting G-Codes

No one likes feeling like they are making a mistake, especially when dealing with something as important as accurate coding. Recently, a certain set of codes (the Therapy Functional Reporting G-Codes [non-payable]) and the way some hospitals’ billing systems process them have left many coders scratching their heads. Here, I’ll do my best to set the record straight.

In January 2013, CMS introduced 42 Therapy Functional Reporting G-codes (non-payable). These G codes are to be reported in conjunction with therapy services (physical, occupational, and speech). CMS also introduced seven complexity/severity modifiers to be used with these G codes. Continue reading