Part B Insider - 2016 Issue 1
Payment Thresholds in Place for Pass Through Drugs
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Article Overview
This article explains selected Medicare OPPS payment updates for hospitals and outpatient services. It covers threshold changes for outlier eligibility, packaging rules for drugs and biologicals, beneficiary cost-sharing, and APC restructuring guidance referenced by CMS. It is useful for hospital outpatient coders, revenue cycle staff, and anyone tracking annual OPPS policy changes.
Why This Topic Matters
These annual payment updates affect how outpatient services are paid and how hospitals monitor packaging, outlier eligibility, and APC-level policy changes. Understanding the scope of the changes helps billing and coding teams stay aligned with CMS updates.
What You Will Learn
- How OPPS payment thresholds change from year to year
- What the article says about outlier payment eligibility
- How packaging thresholds apply to certain drugs and biologicals
- What general information is provided about beneficiary copayments
- What CMS says about APC restructuring at a high level
Who Should Read This
- Hospital outpatient coders
- Revenue cycle staff
- Billing specialists
- Compliance teams
- Health information management professionals
- Practice administrators
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