HCFA Updates APC Guidelines

The Health Care Financing Administration (HCFA) issued several APC-related program memoranda during the last nine weeks to coincide with the implementation of the new outpatient prospective payment system (OPPS). Some of the documents correct or augment earlier transmittals.

Although the new payment method certainly represents a major change for facilities, remember that HCFA has never done anything like this, and confusion should be expected. The best way for coders, clinicians and administrators to keep up with HCFAs changes is to visit the Whats New section of HCFAs Web site at www.hcfa.gov/whatsnew/ regularly. To check out the program memoranda, go to www.hcfa.gov/ pubforms/transmit/memos/comm_date_dsc.htm. If Internet access is not available, call the HCFA press office at 202-690-6145 and ask to be put on the mailing list for releases.

Highlights of HCFAs recent announcements include:

HCFA has released a list of long descriptors for drugs, biologicals and devices eligible for transitional pass-through payments, as well as for new technology. The memo creates 11 new APCs for medical devices and six new APCs for blood and blood products and touches on several other issues. For more information, see the program memo at www.hcfa.gov/ pubforms/transmit/A0061.pdf.

Program memo A-00-60 (www.hcfa.gov/pubforms/ transmit/A0060.pdf) provides a list of questions and answers regarding the APC system.

HCFA has delayed imposition of APC billing until Jan. 1, 2001, for independent laboratories that provide services for Medicare outpatients.

HCFA has set deadlines for applications regarding new technology or transitional pass-through status for medical devices. HCFA plans to update its list quarterly, and items to be considered for the April 1, 2001, update must be filed by Dec. 1, 2000. For the July 1, 2001, update, file by March 1, 2001. For the Oct. 1 update, file by June 1. The program memo (www.hcfa.gov/medicare/passdead.htm) contains detailed application instructions.

The Claims Expansion and Line-Item Processing (CELIP) software, used by HCFA to process APC claims, was updated July 7 to fix some bugs found in the version released in June. Facilities can acquire versions of two other software programs the Outpatient Code Editor software designed for use by fiscal intermediaries to assign outpatient services to an APC, and PRICER, which assigns payment amounts of APCs. For more information about the software, including its cost, call HCFA at 410-786-1800.

HCFA published a list of inpatient-only codes that wont be paid under APCs if performed on an outpatient basis, but the list contained some errors. An Aug. 1 program memorandum (www.hcfa.gov/medlearn/refopps.htm) offers a list of codes that were removed from the inpatient-only list, as well as instructions for preventing improper denials of these codes.

HCFA released a list of contingency plans and instructions to be invoked if either fiscal intermediaries or facilities are unable to comply with [...]

- Published on 2000-09-01