CMS Issues Corrections to ’12 OPPS

The Centers for Medicare & Medicaid Services (CMS) is correcting errors in the 2012 Outpatient Prospective Payment System (OPPS) final rule. A corrections document, posted Nov. 30, updates some language, adding and deleting services, and tweaking Tables 19 and 59. Corrections are effective Jan. 1 of this year.

CMS explains that the organization erred in its inclusion of some line items that were eligible for payment in the claims year but did not meet Medicare eligibility for payment. This affects median costs used to make payment because it changed the data used to model the fixed-dollar outlier threshold.

Ambulatory Surgical Center CASCC

Correction to the programming logic prompted changes to Table 19 – Final APC Exceptions to the 2 Times Rule for CY 2012 of the OPPS final rule, put several APCs in violation of the two-times rule, and prompted the addition of several APCs:

APC 0105 Repair/revision/removal of pacemakers, AICDs, and vascular access devices

APC 0263 Level 1 miscellaneous radiology procedures

APC 0655 Insertion /replacement/conversion of a permanent dual chamber pacing electrode

Three APCs were removed because the recalculated median costs caused several APCs to no longer display violations of the two-times rule:

APC 0262 Plain film of teeth

APC 0341 Skin tests

APC 0660 Level II otorhynolaryngologic function tests

Changes to Table 59 – Estimated Impact of the Final CY 2012 Changes for the Hospital Outpatient Prospective Payment System include a preamble updated to reflect the correct number of hospitals used in the calculation (CMS was one off.) and an estimated total decrease in payment resulting in a decline of 0.1 percent.

View the revised payment rates on the CMS website.


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