AHA Coding Clinic® for HCPCS - 2003 Quarter 2
OPPS final rule €œclears€ the air on self-administerable drugs
by Kathy Reep Vice-President Florida Hospital Association The final rule on changes to the outpatient prospective payment system contained in the November 1 Federal Register also includes clarification on various policies related to hospital pharmacy services, particularly the provision of self-administerable drugs to hospital outpatients. Key provisions of the final rule are as follows: Drugs packaged as supplies. The final rule provides coverage, although no separate payment, for those drugs that are directly related and integral to performing a procedure or furnishing a service on an outpatient basis. The Centers for Medicare & Medicaid Services (CMS) considers these drugs...
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Article Overview
This article explains a Medicare outpatient prospective payment system update from the Federal Register that addresses hospital pharmacy services and outpatient drug billing. It focuses on broad policy areas such as packaged supplies under APC payment, handling of self-administerable drugs, billing considerations for newly approved drugs, and treatment of wasted medication in hospital outpatient settings. The article is relevant to hospital coders, revenue cycle staff, pharmacy personnel, and compliance teams that work with OPPS billing rules and CMS policy updates.
Why This Topic Matters
The rule clarifications affect how hospitals understand which outpatient drug charges are bundled, when separate billing may be considered, and how pharmacy-related costs interact with Medicare payment methodology. It is useful for organizations seeking to align outpatient billing and compliance practices with CMS guidance.
Article Sections
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Key provisions of the final rule
Overview of the main outpatient payment policy topics addressed in the rule, including pharmacy-related coverage and billing considerations.
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Drugs packaged as supplies
Discussion of drugs that CMS treats as part of the outpatient service payment and general circumstances in which that policy applies.
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Billing patients for non-packaged self-administrable drugs
Discussion of compliance concerns related to outpatient drugs that are not bundled into the service payment.
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Billing for new drugs
Summary of guidance on temporary billing approaches for newly approved drugs before permanent coding or pass-through status is established.
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Wasted drugs
Discussion of pharmacy handling issues when only part of a drug package is used and the remainder is not administered.
What You Will Learn
- How the article frames outpatient pharmacy-related changes under OPPS
- What broad categories of drugs are discussed as part of bundled outpatient payment policy
- How the article addresses billing considerations for newly approved drugs
- What the article says about medication waste in the hospital outpatient setting
- Which compliance and payment topics are emphasized for hospital outpatient departments
Who Should Read This
- Hospital coders
- Outpatient billing staff
- Revenue cycle teams
- Hospital pharmacy personnel
- Compliance officers
- Medicare reimbursement specialists
Codes Discussed
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