News: OPPS proposal introduces packaging, bundling similar to DRG system
July 18, 2013
CDI Strategies - Volume 7, Issue 15
By Kimberly Hoy, JD
The Outpatient Prospective Payment System (OPPS) proposed rule put on display by CMS on July 8. In it, CMS proposes significant changes to the ambulatory payment classifications (APC) packaging system and visit codes to further bundle and consolidate payment into large categories.
CMS goes so far as to say the OPPS is a “hybrid” of a prospective payment system and a fee-for-service system, and proposes extensive changes to move the system “closer to a prospective payment system,” similar to the IPPS DRG system. It proposed seven new categories of services that would be packaged rather than paid separately including:
- Drugs, biological, and radiopharmaceuticals that function as supplies to a test or procedure
- Drugs and biologicals that function as supplies or devices to surgical procedures
- Certain clinical diagnostic lab tests
- Add-on code procedures
- Ancillary services assigned status indicator “X” (e.g., simple x-rays, some pathology, many services in the medicine section of the CPT)
- Diagnostic tests on the bypass list
- Device removal procedures
In addition to packaging specific items, CMS is creating 29 new “comprehensive APCs” that function more like mini-DRGs based on procedures that are highly device dependent, (i.e., they include a device with a high cost compared to the procedural services). CMS has assigned 148 HCPCS codes to these new comprehensive APCs.
Editor’s Note: Hoy is a regulatory specialist for HCPro, Inc., in Danvers, Mass., and teaches the Medicare Boot Camp. This article is an excerpt from the Medicare Insider e-newsletter.