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July OPPS Update

July OPPS Update June 19, 2019

CMS has published an OPPS update to billing and payment policies that will take effect July 1, 2019.   There are multiple additions, deletions and revisions impacting HCPCS codes, Ambulatory Payment Classifications (APCs), Modifiers, Status Indicators, and Revenue Codes.

The services impacted by the new changes include:

  • Transcatheter cardiac valve procedures
  • Balloon continence device procedures
  • Bone strength studies
  • Anatomic 3D printing services
  • Proprietary laboratory analyses services
  • Chemotherapy drugs

Having a current and accurate chargemaster (CDM), combined with staff education, is critical to ensure compliant reimbursement, optimal charge capture, avoid unnecessary denials and improve revenues.    Ideally, your CDM should be reviewed and revised on a quarterly basis in conjunction with the CMS updates. 

The CMS update can be found here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4313CP.pdf

The Medlearn Summary Article can be found here:  https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11318.pdf

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