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Wednesday Jul 16, 2014

CMS looks to add new code to track care provided off hospital grounds

If you're in a family medicine practice owned by a hospital or other health system, the recently proposed 2015 Medicare physician fee schedule(s3.amazonaws.com) offers some new reporting requirements.

The Centers for Medicare & Medicaid Services (CMS) wants to require hospitals and physicians to report a coding modifier for those services furnished in an off-campus, provider-based department.  

The modifier would be reported on both the claim form for physicians’ services and on hospital outpatient claims. CMS defines a hospital campus to be the physical area immediately adjacent to the provider's main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis by the CMS regional office. The new rule would apply to everything outside of that.

CMS said the information collected will help it improve its practice expense data and methodology under the physician fee schedule and more appropriately account for the different resource costs among traditional office, facility, and off-campus, provider-based settings.

The AAFP has prepared a summary of these and other changes proposed by CMS. You can access the full proposed rule (www.cms.gov) through the CMS web site.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Posted at 11:07AM Jul 16, 2014 by David Twiddy

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