OPPSPAYMENTPACKAGING--PACEMAKERPROCEDURES

Out lier Adjust m ent ?Under OPPS, a claim paid by APCmay become eligible for additional reimbursement in the form of an outlier adjustment if two criteria are met:

- In 2023, the cost of the procedure, as measured by total covered charges x the facility?s ?Cost to Charge?ratio, must be more than $8,625 above the regular APCrate of reimbursement, and

- The facility?s cost must exceed 1.75 x the APCrate

Here?s an example of the OPPSoutlier calculation for a claim with very high charges:

REVISED MOON, IM AND DND RECEIVEOMB APPROVAL

On January 23, 2023, the Office of Management and Budget (OMB) approved three revised forms that are required by April 27, 2023. Those three revised forms are:

- Medicare Outpatient Observation Notice (CMS-10611)

- Important Message from Medicare (CMS-10065)

- Detailed Notice of Discharge (CMS-10066)

The revisions involved adding standardized nondiscrimination language required on forms and notices The original content and intent of the notices remain unchanged The new forms and instructions can be accessed in the PDE under t he Advisor tab