The Centers for Medicare & Medicaid (CMS) proposed rule changes to the 2010 Outpatient Prospective Payment System (OPPS) recently went into effect. There has been quite a bit of outreach from other state's in regards to this final rule especially in regards to the physician supervision requirements for outpatient therapeutic services. If you are a Critical Access Hospital (CAH) or rural hospital in Colorado and are concerned about this new ruling, we need to hear from you!
According to information gathered on a recent call with CMS:
• Although the CAH Conditions of Participation don’t require a CAH to have a physician on-site 24/7, the 2010 OPPS Final Rule does require a physician or non-physician practitioner (NPP) to be on-site and immediately available whenever the CAH is providing OP therapeutic services in order to bill for these services, including normal business hours, after hours/overnight. Having the physician or NPP on-call is not sufficient to meet the 2010 OPPS final rule billing requirements for these services. Observation services and IV treatments are included in OP therapeutic services.
• An ED physician or NPP could potentially provide direct supervision of OP therapeutic services (within their scope). It is up to the CAH’s discretion to determine if the ED physician can meet the “immediately available” criteria under the rule depending on their patient volume.
• “Immediately available” means the physician or NPP can be interrupted – for example, a surgeon performing an 8-hour surgery is not considered immediately available.
CMS has received many questions and comments since the 2010 OPPS rule went into effect. CRHC has been contacted by Senator Udall's office to inquire about how this rule will impact CAHs and if we should be actively trying to change this.
Please contact Terri Hurst, th@coruralhealth.org, and let CRHC know what sort of impact this rule has on your facility’s ability to provide OP therapeutic services. We’ll keep you informed of any additional guidance from CMS on this issue.
