HCPro, JustCoding Outpatient - 2016 Issue 9 (March)
Determine how Bipartisan Budget Act impacts off-campus departments, modifier –PO
March 1st, 2016
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Article Overview
This article reviews recent CMS guidance, statutory changes, and regulatory definitions affecting off-campus provider-based departments and modifier –PO. It is aimed at hospital coders, compliance staff, and reimbursement professionals who need to understand how the article frames the interaction between CMS guidance, Medicare regulations, and the Bipartisan Budget Act’s off-campus payment provisions. The discussion is organized around how different categories of hospital departments and services are treated under the relevant policy frameworks, and it highlights where CMS has indicated more guidance is expected.
Why This Topic Matters
The topic affects hospital outpatient reporting, compliance, and payment treatment for services furnished in off-campus settings. Understanding the scope of the article helps readers determine whether they need to follow evolving CMS guidance and statutory provisions related to provider-based departments.
Article Sections
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CMS guidance and recent legislation
Introduces the recent CMS FAQs and legislative changes that frame the article’s discussion of off-campus departments and reporting requirements.
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How modifier –PO relates to off-campus provider-based departments
Discusses the general purpose of the modifier and the ways CMS guidance aligns it with broader off-campus department policy.
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Section 603 and alternative payment treatment
Summarizes the statutory off-campus payment framework and the categories of hospital department services addressed by that framework.
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Regulatory definitions and exceptions
Reviews the regulatory definition of provider-based departments and the types of locations or services that are treated differently under the relevant rules.
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Comparison of definitions and applicability
Presents a side-by-side comparison of the article’s three off-campus definitions and which kinds of services or departments they cover.
What You Will Learn
- How CMS guidance and legislation are affecting off-campus hospital department policy
- What broad categories of services and departments are discussed in relation to modifier reporting
- How the article compares statutory, regulatory, and reporting-oriented definitions of off-campus departments
- Which organizations and regulatory sources are referenced in the discussion
- What areas CMS indicated may receive additional guidance
Who Should Read This
- Hospital coders
- Compliance professionals
- Revenue cycle staff
- Medicare reimbursement specialists
- Hospital outpatient billing teams
Modifiers Discussed
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