Practice Point: 2014 OPPS Final Rule Drives Critical Documentation Elements

The tide is turning for healthcare as we are moving from fee-for-service to a pay-for-performance–based healthcare system. This was evidenced by the recent release of the Centers for Medicare & Medicaid Services (CMS) 2014 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates final rule with comment period.1

The final rule streamlines the current 5 levels of outpatient clinic visit codes, replacing them with a single Healthcare Common Procedure Coding System (HCPCS) code describing all clinic visits. The CMS states: “A single code and payment for clinic visits is more administratively simple for hospitals and better reflects hospital resources involved in supporting an outpatient visit. The current 5 levels of outpatient visit codes are designed to distinguish differences in physician work.”2

Per the CMS: “Under this proposal, all clinic visits would be reported using the new HCPCS G code, regardless of whether the patient has been registered as an inpatient or outpatient of the hospital within the 3 years prior to a visit” (see page 670 of Final Rule). Regarding non-Medicare payors, it will be the facility’s responsibility to maintain the current billing structure for non-Medicare payors until further notified by the payor. In addition, the CMS also announced it will create 2 payment bundles—“high price” and “low price”—to reflect the various skin substitute products on the market (see pages 332–342).1

Lastly, CMS clearly states that it is important to continue to document and report Current Procedural Terminology/HCPCS codes and charges supporting the work performed for the visit. The outpatient documentation will be reviewed for rate setting in the future (see page 671 of Final Rule).1

Read the rest of the article at Advances in Skin & Wound Care.

An excerpt from an article originally published in Advances in Skin & Wound Care, written by Cathy Thomas Hess, BSN, RN, CWOCN, VP and Chief Clinical Officer at Net Health