Wiki CMS OPPS Final 2014 Rule/Clinic Visits

[allaire_s]

For those of you who have been following the release of the final OPPS rule for 2014, you know that Medicare has collapsed the five clinic visit levels into one APC payment. I did not want to have a discussion about whether or not it was the right decision.

I wanted to reach out to hospital outpatient billers who bill government and commercial payers.

So clinic visits for Medicare patients will be billed with G0463 no matter what.

If I understand correctly, when a patient has a nurse-only visit, for commercial payers you would bil a 99211 only, not a code selected from a matrix, is this correct?

So if from Medicare you would get a set rate of G0463 and for commercial payers you would get the contracted rate for 99211, is there a reason to keep you current facility matrix and keep selecting a charge based on the matrix?

Thanks!