Radiology Compliance Question of the Week
August 4, 2008
Question:
Does the new Medicare law make any changes to the way radiopharmaceuticals
are paid under the hospital OPPS?
Answer:
Yes, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (HR 6331), which Congress passed on July 16, does include a change. Here's how it goes.
Between January 1 and July 1 of 2008, therapeutic radiopharmaceuticals and brachytherapy sources were paid under hospital outpatient prospective payment system (OPPS) status indicator (SI) "H" (defined as "separate cost-based non-pass-through payment"). Between July 1 and July 15, 2008, they were paid under the SI of "K" (defined as "paid under OPPS; separate ambulatory payment classification [APC] payment")-a reduced rate from SI of H. As a result of the MIPAA provision, between July 1, 2008, and January 1, 2010, Medicare will base hospital OPPS rates on the SI of H.
HR 6331 did not address diagnostic radiopharmaceuticals. But in the 2009 proposed hospital OPPS, the Centers for Medicare & Medicaid Services (CMS) indicated that it would not change the way it pays for diagnostic radiopharmaceuticals and contrast agents. Medicare will continue to bundle payments for these supplies into the APC of the major service or procedure performed.
HR 6331 can be found at http://thomas.loc.gov/. Under "Search Bill
Text," type HR 6331, and select "Bill Number" under that
entry.
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