Physician's Coding Strategist-Details of the changes for the final APC rule
Here are more details of the changes lawmakers included in last year's budget bill affecting the final rule implementing the new Medicare prospective payment system (PPS) using ambulatory payment classifications to reimburse hospital-based outpatient services, which goes into effect July 1.
According to Program Memorandum Transmittal A-00-09 from the Health Care Financing Administration to its fiscal intermediaries, the changes:
1. extend the 5.8% reduction in operating costs and 10% reduction in capital costs due to expire December 31, 1999, to July 1, 2000. The bottom line is that this will permit hospitals to continue billing that this part of their capital costs for six months longer than expected;
2. require PPS payment weights, rates, payment adjustments, and groups be updated annually;
3. establish budget-neutral outlier adjustments based on the cost-adjusted charges for all services included on the submitted outpatient bill for services furnished before Jan. 1, 2002, and thereafter, based on the individual services billed using the appropriate department-specific cost-charge ratio for each service;
4. provide transitional passthroughs for the additional costs of new and current medical services, drugs, and biologicals for at least two but no more than three years;
5. require several types of drugs and services not reimbursed under the Medicare program to be covered under PPS during the transition process. Those could include experimental drugs the U.S. Food and Drug Administration has not approved that have been clinically shown to significantly reduce problems with diseases;
6. include implantable devices, durable medical equipment, prosthetics, and items used in diagnostic testing under the PPS;
7. limit beneficiary copays for services paid under PPS to the inpatient hospital deductible;
8. pays for acute dialysis, such as for poisoning, under the PPS.
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