CMS updates issued for outpatient PPS, physician fee schedule

Healthcare Financial Management, Nov, 2004

CMS has published the fourth- quarter update to the current hospital outpatient PPS rules. Some of the changes include payment for drugs and biologicals recently approved by the Food and Drug Administration, newly approved drugs for pass-through payments, APC additions, and code additions and deletions. All changes in the update are effective October 1, 2004.

CMS also published an update to the 2004 Medicare physician fee schedule database. The update includes numerous CPT/HCPCS code changes with effective dates and changes in payment amounts. Carriers are required to give providers 30 days' notice before implementing the revised payment amounts reflected in the update. According to CMS, carriers are not required to search their files to retract payment for claims already paid or to retroactively pay claims. However, carriers must adjust claims brought to their attention. The update is effective January 1, 2004.

To review the outpatient PPS update, go to www.cms.hhs.gov/manuals/pm_trans/R290CP.pdf. To review the update to the 2004 physician fee schedule database, go to www.cms.hhs.gov/manuals/ pm_trans/R278CP.pdf.