CMS Manual System

CMS Manual System

Pub 100-02 Medicare Benefit Policy

Transmittal 152

Department of Health & Human Services (DHHS)

Centers for Medicare & Medicaid Services (CMS)

Date: December 29, 2011 Change Request 7672

SUBJECT: January 2012 Update of the Hospital Outpatient Prospective Payment System (OPPS)

I. SUMMARY OF CHANGES: This Change Request implements several changes and clarifications in the manual requirements of chapter 6 for the provision of hospital outpatient therapeutic and diagnostic services finalized in the CY 2012 OPPS/Ambulatory Surgical Center (ASC) Final Rule.

EFFECTIVE DATE: January 1, 2012 IMPLEMENTATION DATE: January 3, 2012

Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.

II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED

R/N/D CHAPTER / SECTION / SUBSECTION / TITLE

R

6/20.4.4/Coverage of Outpatient Diagnostic Services Furnished on or After January 1, 2010

R

6/20.5.2/Coverage of Outpatient Therapeutic Services Incident to a Physician's Service

Furnished on or After January 1, 2010

III. FUNDING: For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs) and/or Carriers: No additional funding will be provided by CMS; Contractor activities are to be carried out within their operating budgets.

For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.

IV. ATTACHMENTS: Manual Instruction Recurring Update Notification *Unless otherwise specified, the effective date is the date of service.

Attachment ? Recurring Update Notification

Pub. 100-02 Transmittal: 152 Date: December 29, 2011 Change Request: 7672

SUBJECT: January 2012 Update of the Hospital Outpatient Prospective Payment System (OPPS)

Effective Date: January 1, 2012 Implementation Date: January 3, 2012

I. GENERAL INFORMATION

A. Background: This Change Request implements several changes and clarifications in the manual requirements of chapter 6 for the provision of hospital outpatient therapeutic and diagnostic services, finalized in the CY 2012 OPPS/Ambulatory Surgical Center (ASC) Final Rule.

B. Policy:

1. Physician Supervision

In Pub. 100-02, Medicare Benefit Policy Manual, chapter 6, several revisions are being made to the standards governing the supervision of hospital or CAH outpatient therapeutic services. Currently, CMS requires direct supervision of these services except for nonsurgical extended duration therapeutic services (extended duration services), for which CMS allows general supervision during a portion of the service at the discretion of the supervising practitioner. To date, for purposes of the hospital outpatient setting CMS has only defined direct and general supervision, and CMS has only defined general supervision insofar as it applies to the provision of extended duration services. CMS is now providing that it may assign general or personal supervision for the duration of the service to certain hospital outpatient therapeutic services. To enable such assignment, CMS is defining those levels of supervision using the definitions that are used in the Medicare Physician Fee Schedule. Second, CMS is providing that as specified in its regulations, in addition to direct supervision certain nonphysician practitioners may furnish the required general or personal supervision.

2. Definition of Hospital Outpatient Therapeutic Services

In the same section of the manual, CMS is slightly revising the language that is used in describing hospital outpatient therapeutic services, consistent with its clarification of the definition of these services in the CY 2012 OPPS/ASC Final Rule.

II. BUSINESS REQUIREMENTS TABLE Use "Shall" to denote a mandatory requirement Number Requirement

7672.02.1 Medicare contractors shall refer to Pub.100-02, Medicare Benefit Policy Manual, chapter 6, sections 20.4 and 20.5 for the latest revisions.

Responsibility (place an "X" in each applicable column) A D F C R Shared- OTHER / M I A H System B E R H Maintainers

RI MM I AA E CC R

F MV C I C MW SS S F S X X X

III. PROVIDER EDUCATION TABLE

Number 7672.02.2

Requirement

A provider education article related to this instruction will be available at shortly after the CR is released. You will receive notification of the article release via the established "MLN Matters" listserv. Contractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within one week of the availability of the provider education article. In addition, the provider education article shall be included in your next regularly scheduled bulletin. Contractors are free to supplement MLN Matters articles with localized information that would benefit their provider community in billing and administering the Medicare program correctly.

Responsibility (place an "X" in each

applicable column)

A D F C R Shared- OTHER

/ M I A H System

B E R H Maintainers

MM AA C C

R I F MV C

I

I C MW

E SSSF

R S

X X X

IV. SUPPORTING INFORMATION

Section A: For any recommendations and supporting information associated with listed requirements, use the box below: N/A Use "Should" to denote a recommendation.

X-Ref

Recommendations or other supporting information:

Requirement

Number

Section B: For all other recommendations and supporting information, use this space: N/A

V. CONTACTS

Pre-Implementation Contact(s): Marina Kushnirova at marina.kushnirova@cms.

Post-Implementation Contact(s): Contact your Contracting Officer's Technical Representative (COTR) or Contractor Manager, as applicable.

VI. FUNDING

Section A: For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs), and/or Carriers:

No additional funding will be provided by CMS; contractor activities are to be carried out within their operating budgets.

Section B: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download