tci Outpatient Facility Coding Alert - 2013 Issue 4
Reimbursement: Don't Miss These New Opportunities for Procedure Payments
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Article Overview
This reimbursement-focused article explains April 2013 updates affecting OPPS and ASC payment processing. It is aimed at providers, coders, and billing staff who need to track newly payable services, pass-through drug and biological status changes, corrected payment rates, APC assignments, and retroactive claim adjustment timing. The article also references CMS guidance and highlights why system updates matter for accurate reporting and reimbursement.
Why This Topic Matters
The changes described can affect how facilities report services and drugs, how payments are calculated, and whether prior claims may need adjustment. Keeping payment files current helps reduce missed reimbursement and incorrect billing outcomes.
Article Sections
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Add New Services and Pass-Through Status
This section summarizes newly added OPPS services and changes in pass-through status for certain drugs and biologicals. It also notes related payment-list updates and the broader context for these April 2013 changes.
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Correct Payment Rates for Existing Services
This section covers revised payment rates for existing procedures and corrected ASC payment information for selected HCPCS items. It also mentions the retroactive effective date for the corrections and the potential need for claim adjustments.
What You Will Learn
- What types of OPPS and ASC updates were announced for April 2013
- How newly added services and pass-through status changes affect reimbursement reporting
- What categories of procedures and HCPCS items received corrected payment rates
- Why retroactive payment corrections may require claim review and adjustment
- How APC and ASC payment indicator changes fit into the update context
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Hospital outpatient departments
- Ambulatory surgical centers
- Compliance staff
- Practice administrators
Codes Discussed
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