HCFA delays outpatient PPS by one month
HCFA delays outpatient PPS by one month
At press time, it was uncertain whether the delay would have any impact on the final PPS regulation for ambulatory surgery centers, which is scheduled to be published in November and implemented in April 2001.
HCFA publishes list
In other positive news, on May 12, HCFA released the list of items eligible for payment as new technologies or transitional pass-throughs. The list is available at the HCFA Web site, www. hcfa.gov. (For more information on payments for new technologies and transitional pass-throughs, see Same-Day Surgery, May 2000, p. 49.)
In terms of the PPS delay, DeParle asked that hospitals not collect deductibles or coinsurance from Medicare beneficiaries beginning Aug. 1 until HCFA can notify the beneficiaries of the correct amount. This step will ensure beneficiaries are charged the correct coinsurance amount, she explained. In July, HCFA will work with hospitals to inform beneficiaries that the PPS-triggered changes in Medicare payments could mean changes in the amount of coinsurance — usually less — that beneficiaries will need to pay, DeParle wrote. "We will provide all hospitals with a plain English’ flier to distribute to beneficiaries."
HCFA is intensifying its efforts to provide clear and accurate training to fiscal intermediaries and hospitals, DeParle said. "Unfortunately, this one-month postponement is critical to ensure that HCFA and the hospital industry are ready for this significant change," she wrote. ". . . By continuing to work together, I am confident that we will overcome the challenges posed by the implementation."
And what are those challenges? According to the AHA, they include fiscal intermediary staff who can’t answer coding questions, incorrect information from intermediaries — even from an intermediary who has led training, and contradictory instructions from HCFA to fiscal intermediaries. Eric Zimmerman, JD, associate with McDermott, Will & Emery in Washington, DC, expressed concern when HCFA initially refused to delay implementation. "Not only are most hospital systems not yet ready to handle the new billing requirements, for example, submit claims using accurate coding, but most fiscal intermediaries have not yet brought their systems into compliance," he says. The AHA and several other groups had asked HCFA to delay implementation of the outpatient PPS. In a May 24 letter requesting a delay for the hospital outpatient PPS, the groups listed several examples of operational issues that HCFA has neglected. They include:
• The outpatient code editor (OCE) was delayed until HCFA finalized its payment policy for devices. A final copy was sent to the National Technical Information Service on May 18, three weeks late. (For ordering information, see resource box, above.)
• Vendors have been affected by the continuous changes to the outpatient PPS, the groups charge. In addition, 3M isn’t expected to have a commercial grouper available to sell to hospitals until June 18, the letter said. "If 3M — the developer of the OCE for HCFA — cannot program the software faster, how can any hospital hope to independently program the system in such a short amount of time?" the letter asked.
• The groups said that the software will not be available for Medicare managed care plans to use for noncontracted or out-of-area services for at least six months. "It is not known what hospitals will be paid for these services during this time period," the letter added.
• HCFA promised hospitals would have an opportunity to test claims processing with their fiscal intermediaries during the week of May 29, the groups charged. However, according to the AHA letter, that testing was canceled.
• At press time, the claims line item expansion (CELIP) was delayed for the third time until June 5. "Because the CELIP is the electronic underpinning of the entire payment system, this missed deadline alone makes a timely and accurate implementation improbable," the letter stated.
The groups wanted assurance from officials at the Department of Justice that they will not pursue billing and claims mistakes that might occur during a reasonable period of time after implementation. "Moreover, we need their assurances in writing," the letter said. n
Outpatient Code Editor software for Medicare’s outpatient prospective payment system is available on-line from the National Technical Information Service. Web site: www. ntis.gov/ product/hcfa-outpatient-code-editor.htm. The mainframe software is available for $110 ($440 as a quarterly subscription), plus a shipping and handling fee. The order number for mainframe software is SUB-5452INQ. PC Software for Windows 95 and 98 is available as a quarterly subscription for $360. Individual issues are available for $90 plus a handling fee. Use order number SUB-5451INQ. To order or for more information, contact:
• National Technical Information Service, Springfield, VA 22161. Telephone: (800) 363-2068 or (703) 605-6060. To order a single issue, call (800) 553-6847 or (703) 605-6000.
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