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News You Can Use: Don't Miss Out on Special OPPS Reimbursement

The scoop on the latest pass-through payments for new drugs and technologies


Special OPPS Reimburse-ment Report. A few more financial roadblocks have been lifted for hospitals.
 
CMS has unveiled special payments available under the outpatient prospective payment system for three additional drugs and four additional services.
 
Here's what you need to know. Effective April 1, Medicare outpatient coverage includes:
 
For injectable drugs:
   
Daptomycin (antibiotic for serious staph infections) at 31 cents per 1 mg     
   
Risperidone (antipsychotic) at $131.86 per 12.5 mg
   
Rasburicase (treatment for high uric acid levels resulting from cancer treatments) at $105.54 per 0.5 mg.
 
For technologies:
   
the insertion of a special device for measuring and monitoring acid levels associated with gastroesophageal reflux disease, paid at $450
   
laser procedure that vaporizes the prostate and controls bleeding before and after the procedure, at $3,750
   
concurrent or immediate placement of a balloon catheter in the breast for interstitial radiation therapy following a partial mastectomy, at $2,750 (delayed placement, at $3,250).
 
Resource: To see the payment update, go to the CMS Web site manuals/pm_trans/R132CP.pdf.


Relief for Rural and Small Urban Hospitals. Financially struggling hospitals in rural areas and urban sites that serve a population of fewer than 1 million got a morale boost from CMS on  March 31.
 Starting with discharges on or after April 1, 2004, the Medicare reform bill will officially be walking the walk when it comes to improved disproportionate share reimbursement.
 
CMS announced that $12 billion has been earmarked for better pay over the next 10 years, effectively decreasing the outlier threshold for extra payments in unusually costly cases from $31,000 to $30,150.
 The provisions in the new Medicare law also lift the cap on DSH payment adjustments from 5.25 percent to 12 percent for urban hospitals fewer than 100 beds, sole community hospitals, and rural hospitals with fewer than 500 beds.
 
More good news: CMS has made permanent a single standardized amount to be used in determining Medicare payments to all hospitals - not the previous two-tiered system that favored hospitals in large urban areas.


How Disproportionate Share Hospital Payments Are Shaping Up for 2004. CMS reveals forecast and final tallies on states' funding. 
 
Hospitals that serve a disproportionate share of low-income or uninsured patients got a peek at this year's federal funding in the March 26 Federal Register - as well as the final word on allotments for previous fiscal years.
 
CMS says that the preliminary 2004 DSH allotment is $10.15 billion, up from $8.75 billion in 2003. The 2004 estimate includes the one-time DSH increase implemented by the Medicare Prescription Drug Improvement and [...]

- Published on 2004-04-16