Final OPPS Rule Increases Drug Payments

HealthLeaders Media Staff, for HealthLeaders Media , November 5, 2012

By collecting data on beneficiary function over an episode of therapy services, CMS hopes to better understand who uses therapy services and how a patient's functional limitations change over time as a result of receiving therapy.

All this data gathering comes with the long-term goal of developing an improved payment system for therapy services that pays appropriately and similarly for efficient, effective services without encouraging the provision of medically unnecessary or excessive services, says Shah. All of the requirements that hospitals need to be aware of are outlined in the MPFS.

"We are likely to see more information in upcoming transmittals and Medlearn Matters articles, but in order to begin making operational changes now to be ready for January 1, hospitals should read the therapy services section of the Physician Fee Schedule Final Rule now," Shah says.

CMS is not changing the payment system, or the rules governing always vs. sometimes therapy, or coverage requirements, but it is changing what data therapists must report.

The requirements go live January 1, but hospitals have a six-month testing period. They will not be penalized for not following the requirements until July 1.

"This really is the single largest operational change that will impact hospitals in terms of the OPPS and MPFS final rules so therapy departments should get people on board and educated as early as possible and also discuss the necessary charge master changes that will accompany the use of the new G-codes," Shah says.

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