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Coding:

HCPCS Coding Could Get Easier For Providers

Published on Fri Oct 15, 2004

Open Door Forum on new process slated for later this month.

Dramatic increases in the number of coding applications have spurred the Centers for Medicare & Medicaid Services to change the way it updates the Healthcare Common Procedure Coding System.

The revisions, which CMS will institute over the next 18 months, are aimed at making new items and services available more quickly, the agency says in a release. The changes will "improve the development of codes for new technologies, and make it easier to make decisions on coverage and payment for these items, as well as provide a more open, transparent coding process," CMS says.

Medicare won't be the only party using the new system. Medicaid and private insurers are on the bandwagon as well.

Here's what to expect:

  • New Coding Application Deadline. Mark your calendars for Jan. 3, 2005. That's the new earlier deadline for the 2006 coding cycle.

  • Public Meetings. CMS will expand durable medical equipment, orthotics and supplies meetings to include all public requests for HCPCS products, supplies and services. The agency will publish agenda items in advance, including descriptions of the coding requests, the requestor, and the product or service's name. "This change will provide more opportunities for the public to become aware of coding changes under consideration, as well as opportunities for public input into decision-making," CMS says.

  • Appeals Process. Starting in 2007, denied applicants who appeal the decision can have their application reconsidered during the same coding cycle.

  • Public Notice of Decisions. CMS will publish its preliminary and final decisions on its Web site prior to public meetings, to facilitate discussion.

  • Revision of the HCPCS Code Application Form. The format will be more "streamlined and user-friendly," thanks in part to the incorporation of suggestions from users, CMS says.

  • Elimination/Reduction of Requirement for Six Months of Marketing Data. CMS will waive this requirement for drug applications, and reduce the time period to three months for DMEPOS.

    The changes came about from Medicare Modernization Act provisions passed last December. "We are delivering on our promise to our health care partners to create a more effective system for providing patients with faster access to the latest medical technologies," CMS Administrator Mark McClellan says. "By working with patient advocates, health care payers, and the suppliers and manufacturers of medical products, we have been able to identify many opportunities for improvements in the current coding process to keep coding issues from slowing the dissemination of new and improved treatments."

    Got questions? CMS plans to hold an Open Door Forum on the changes Oct. 27.

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