Outpatient Care Issues
AARC to Comment on Hospital Outpatient PPS Final Rule
May 16, 2000
The Health Care Financing Administration (HCFA) published the final rule on the hospital outpatient PPS in the April 7, 2000, Federal Register. Provider payments in the final rule are higher than in initial proposals largely due to adjustments mandated by the Balanced Budget Refinement Act (BBRA) of 1999. The BBRA eliminated the proposed 5.7 percent across-the-board provider cut which was to cover Medicare's reduction in beneficiary coinsurance. The BBRA also provides additional funds for a 3.5-year transition of the system.The final rule divides all outpatient services into 451 APC (Ambulatory Payment Classification) groups based on HCFA's Common Procedural Coding System (HCPCS). A concern for respiratory therapy involves the elimination of two pulse oximetry codes, and payment for a third code for pulse oximetry only as an inpatient service. This was done by HCFA with the perspective that pulse oximetry is a standard of care and should be bundled into other codes. The AARC is submitting comments to HCFA on the final regulation addressing the need to reinstate these codes for diagnostic purposes. RTs may review the final rule on HCFA's web site and submit any comments to Jill Eicher at eicher@aarc.org prior to the June 7 deadline for submission of comments.
Implementation of the hospital outpatient PPS is scheduled for July 1, 2000. The Health Care Financing Administration (HCFA) announced a timeline to implement the prospective payment system (PPS) for hospital outpatient services and promised hospitals help in meeting the July 1, 2000 deadline. HCFA held "train-the-trainer" seminars for financial intermediaries (FIs) in early May. Training material should be posted on HCFA's web site. FIs are required to link to http://www.hcfa.gov and advertise availability of outpatient PPS materials. HCFA also announced plans to broadcast a 45-minute national satellite conference on outpatient PPS in June. It will provide an overview of the new system and changes in processing claims and in medical review and auditing. The conference will be broadcast over the DISH network and Echostar satellite system. Broadcast detail will be posted on HCFA's web site.