CMS has published an Outpatient Payment System (OPPS) correction notice in the Federal Register which contains additional information about the data error that led to CMS to arrive at an inaccurate cost for the hyperbaric oxygen therapy (HBOT) hospital facility fee (called in the document, “the geometric mean cost for APC 5061”).
Thanks to advocacy from the Alliance of Wound Care Stakeholders, the Undersea and Hyperbaric Medical Society (UHMS), many management companies, and a number of hospital systems, CMS corrected what we had determined was an error in their calculations thus avoiding a 40% decrease in HBOT facility fees. CMS has placed a correction notice in the Federal Register, which describes the way the error happened, and which posts a final rate of $135.89, a rate slightly above what was originally reported as the corrected rate.
Excerpt below:
“When an individual claim contains 50 or more units on the primary code’s line used for ratesetting, the OPPS ratesetting programs exclude, or trim, these lines from the calculation of the geometric mean for an ambulatory payment classification (APC). However, this trim was inadvertently not included in the ratesetting process for two APCs: Hyperbaric Oxygen Therapy (APC 5061) and Ancillary Outpatient Services When Patient Dies (APC 5881). We are applying this trim and removing these lines where the primary code’s units contain 50 or more units for CY 2024 OPPS ratesetting. The geometric mean cost for APC 5061 will change significantly as a result of this trim, from what was originally $75.61 to $135.89, because there is a claim for this APC that contained more than 50 units on an individual line that was originally used in CY 2024 OPPS ratesetting.”
I confess that this stuff makes my head explode, but clearly if, “a trim is inadvertently not included in the ratesetting process” for an APC, the result can be a devastating decrease in payment rate. I do not know if this “trimming” process is something that we can monitor, but I do know that anything we can do to get hospitals to submit cost reports correctly would help. At any rate, it’s good news for a change.
Caroline
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
