News you can use: Friendlier OCE Kicks In This Fall

The outpatient code editor (OCE) isn't just for editing anymore: According to CMS program memorandum A-03-069, revised OCE version V4.3 not only pinpoints individual errors but also suggests ways you can fix them. It even tells you why the remedies are necessary. This function contrasts greatly with the old OCE, which only informed you whether edits were present, and when they were, didn't tell you what to do about the issue.
 
You'll need to install the new OCE by Oct. 1, and run any unprocessed claims with service dates of Aug. 1, 2000, or later that have these bill types:
 1. outpatient hospital Part B bills (bill types 12X, 13X, or 14X)
 2. community mental-health center bills (bill type 76X)
 3. bills for home health agencies and comprehensive outpatient rehabilitation facilities that have codes for antigens, hepatitis B vaccines, splints, or casts
 4. Bills containing condition code 07 (Treatment of non-terminal illness - hospice) that have codes for antigens, hepatitis B vaccines, splints, or casts.
 You should also process bills of all other types with service dates on or after April 1, 2002, through the new OCE, as well as outpatient bill types 34X and 75X that contain services other than the ones above (and have service dates on or after April 1, 2002).
Worried about billion-dollar abuses of Medicare, CMS is attempting to overhaul the controversial "average wholesale price" (AWP) system that determines Medicare payments for outpatient drugs. While the agency hasn't come up with a final solution, it published these four suggestions in the Aug. 20 Federal Register:
 
 1. Medicare would pay the same amount that private insurers pay.
 2. Medicare would discount the AWP by 10 to 20 percent in 2004, then continue decreasing payments until they're reasonable (similar to a proposal in the Senate's Medicare reform bill).
 3. Medicare would monitor markets to establish reasonable drug prices.
 4. Medicare would establish competitive bidding for covered drugs, and require drug makers to report their average sales prices. (This option parallels the House of Representatives' approach in its Medicare bill.) To view the proposed rule in full, go to http://www. access.gpo.gov/su_docs/fedreg/ a030820c.html.
CMS recently shed some light on its foggy Web site and became more provider-friendly. The agency's Aug. 12 online update features separate pages for physicians, various types of hospitals, nursing homes, ambulance companies, and other types of providers. "We want doctors, hospitals, and other healthcare providers to know that valuable, updated Medicare information is available to them at a single, easy-to-find Web site," says CMS chief Tom Scully.

- Published on 2003-09-11