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Hospital outpatient PPS proposed rule

This article was originally published in The Gray Sheet

Executive Summary

HCFA's Sept. 8 proposed rule to implement a prospective payment system for hospital outpatient services "fails to account properly for both simple and complex patient encounters and artificially reduces payment levels for certain [ambulatory patient classification] groups," the Medical Device Manufacturers Association says in Jan. 6 comments to HCFA Administrator Nancy Ann DeParle. In addition, device makers should be allowed "to participate in the process of assigning" a HCPCS or CPT code to an APC and have the ability to provide information "regarding clinical utility and resource use" of new or redefined procedures or devices, the association maintains. MDMA also expresses concerns over the proposed rule's noncoverage of certain outpatient procedures and the "lack of a clear schedule for reviewing or revising APC groups." The comment period for the rule has been extended to March 9, HCFA says

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