BILLING NEWS

CMS Proposes 2018 Policy and Rate Changes for Hospital Outpatient Payment Systems and Potential Revision to the Laboratory Date of Service Policy

The Proposed OPPS Payment Update CMS proposes to update OPPS rates by 1.75 percent for 2018. There is also a Potential Revision to the Laboratory Date of Service Policy. For a clinical diagnostic laboratory test, the date of service (DOS) is often the date the specimen was collected, unless certain conditions are met. For example, if the physician orders the test at least 14 days after a patient’s discharge from the hospital and certain other requirements are met, the DOS is the date the test is performed (instead of the date the specimen was collected). Under the current DOS policy, if the test is ordered less than 14 days after the date of the patient’s discharge from the hospital, the hospital must bill Medicare for the test and then pay the laboratory that performed the test, if the laboratory provided the test under arrangement. CMS has received feedback from stakeholders that the DOS policy creates unintentional operational burden for hospitals and the laboratories that perform molecular pathology tests and certain advanced diagnostic laboratory tests (ADLTs). Therefore, CMS is considering potential modifications to the DOS policy that would allow laboratories to bill Medicare directly for molecular pathology tests and ADLTs which are excluded from the OPPS packaging policy and ordered less than 14 days following the date of the patient’s discharge from the hospital. CMS is seeking information from stakeholders on whether these tests, by their nature, are appropriately separable from the hospital stay that preceded the test and therefore, should have a DOS that is the date of performance rather than the date of collection.


INDUSTRY NEWS TAGS: CMS


SHARE THIS NEWS POST:

Billing News By TAG

Billing News By DATE