HCFA slow to issue rules on new outpatient PPS
Baltimore, MD-With a Jan 1, 1999 starting date looming, outpatient providers have been anxiously waiting for the federal government to issue details of a prospective payment system for virtually all Medicare outpatient services. Within seven months, Medicare will drastically alter the way it pays facilities for the technical component of most ambulatory procedures, including most emergency department visits.
However, the Health Care Financing Administration (HCFA) says it doesn't know when the proposed rules will be ready for release. Preliminary outlines of the plan were expected in March. But Baltimore-based HCFA says it has taken longer than expected to get the plan cleared internally.
The delay has alarmed some providers, who complain that it leaves them insufficient time to learn the new system. The proposed system pays providers prospectively using a schedule of flat fees for pre-defined sets of outpatient procedures termed "ambulatory payment classifications" (APCs). The system is similar in concept to the diagnosis-related groups (DRGs) that Medicare uses to pay inpatient claims.
"Until you see the regs, there's no way to know how this is going to affect payments. It'll take at least six months for hospitals to respond, and we're running out of time," says Frank Heydman, coding and reimbursement consultant with The Permanente Medical Group, a division of Kaiser Permanente in Oakland, CA.
Last year, HCFA announced it would launch the system on Jan. 1, 1999. The agency is required to give providers 60 days to comment on the proposed rulemaking and another 60 days following the final rules' publication in the Federal Register. "If we don't have a final rule by Nov. 1, then it's almost a given that we'll have to push back the launch date," according to a HCFA official who asked not to be identified.
[Editor's note: In the July issue, The Managed Care Emergency Department will have an in-depth report on APCs and what they will mean for physicians and hospitals.]
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