AMA Clinical Examples in Radiology - 2012 Bulletin 2
Hospital Outpatient Prospective Payment System Final Rule
Hospital Outpatient Prospective Payment System Final Rule The Centers for Medicare and Medicaid Services (CMS) finalized the hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) rule on November 1, 2012. For 2013, the CMS will use a conversion factor of $71.313 in the calculation of the national unadjusted payment rates for those items and services for which payment rates are calculated using geometric mean costs. The CMS will also use a reduced conversion factor of $69.887 in the calculation of payments for hospitals that fail to report required quality measures. The American College of...
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Article Overview
This article covers Medicare’s 2013 hospital outpatient payment final rule, radiology coding and payment classification issues, and related advocacy efforts affecting hospital outpatient services. It also discusses broader claim-edit and payment-rule standardization work in Colorado and the importance of accurate hospital charge and cost reporting for bundled radiology services. The content is most relevant to hospital coders, radiology billing staff, compliance teams, and reimbursement professionals who follow CMS payment policy and APC-related updates.
Why This Topic Matters
The article helps readers understand which kinds of outpatient payment and radiology reimbursement issues were being addressed for 2013 and why hospitals needed to pay attention to charge masters, cost reporting, and payment classifications. It is also relevant to organizations monitoring payer-edit standardization efforts and specialty-society advocacy related to imaging reimbursement.
Article Sections
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Hospital Outpatient Prospective Payment System Final Rule
Overview of the CMS final rule for hospital outpatient and ambulatory surgical center payment policy, including broader reimbursement changes for 2013.
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Centers for Medicare and Medicaid Services 2013 Medicare Fee Schedule: the ACR Says Imaging Cuts are Dangerous, Unfounded and Unnecessary
Discussion of radiology payment policy concerns raised by the ACR and related advocacy around imaging reimbursement and access to care.
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Colorado Clean Claims Task Force Focuses on Development of Standardized Set of Claim Edits and Payment Rules
Summary of a Colorado initiative aimed at creating standardized claim edits and payment rules, including participation by national organizations and specialty groups.
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Importance of Pricing Radiology Bundled CPT Codes Accurately in Hospital Outpatient Setting and What You Can Do to Help
Explanation of how bundled radiology payment topics relate to hospital charge master maintenance, cost reporting, and outpatient payment classification work.
What You Will Learn
- The general scope of CMS outpatient payment policy changes addressed in the article
- How radiology advocacy groups were responding to Medicare reimbursement issues
- Why standardized claim edits and payment rules were being discussed in Colorado
- Why accurate hospital charge and cost reporting matters for bundled outpatient radiology services
Who Should Read This
- Hospital outpatient coders
- Radiology billing and reimbursement staff
- Compliance and revenue integrity teams
- Healthcare policy analysts
- Medical society reimbursement advocates
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