Dissecting the 2025 OPPS proposed rule on the July NAHRI Quarterly Call
NAHRI members received association updates and learned about provisions in the 2025 Outpatient Prospective Payment System (OPPS) proposed rule that could impact revenue integrity professionals during the July NAHRI Quarterly Call.
Association updates
The call opened with NAHRI Director Nicole Votta providing the latest association updates.
The 2024 Revenue Integrity Symposium (RIS) will be held September 12-13 at the Hilton Chicago/Oak Brook Hills Resort & Conference Center in Oak Brook, Illinois. RIS is the premier event for revenue integrity, revenue cycle, and Medicare compliance education and networking. Attendees will learn from trusted experts with cutting-edge insights that will empower them to ensure compliance with regulatory changes, maximize revenue, enhance workflow, and improve program design. Download the 2024 RIS digital brochure to learn more about the event.
The 2024 Revenue Integrity Salary Survey is open now through September 20. The survey gathers information from revenue integrity professionals on compensation trends, professional experience, program staffing, and more. The results will be published later this year in the 2024 Revenue Integrity Salary Report.
NAHRI recently welcomed a new member, Michele Bear, DBA, MBA, CHRI, CRCR, CHC, CPC, to its Advisory Board. Bear is a revenue cycle executive director of revenue integrity, chargemaster, revenue cycle reporting and data analytics, revenue cycle quality assurance, and revenue cycle team member engagement at Baptist Health in Jacksonville, Florida.
2025 OPPS proposed rule insights
Following the association updates, NAHRI Advisory Board members detailed several provisions in the 2025 OPPS proposed rule that revenue integrity professionals should pay particular attention to.
Of note, CMS included a request for information (RFI) on cardiac computed tomography (CT) services in the rule. The agency created this RFI in response to concerns related to coding, claim edits, and payment for these services. If revenue integrity professionals want to respond to the RFI, they should consider the resources needed to perform CTs, other revenue code options, and Current Procedural Terminology (CPT ® ) descriptors, said NAHRI Advisory Board member John Settlemyer, MBA, MHA, CPC, CHRI, assistant vice president, enterprise revenue management/CDM operations at Atrium/Advocate Health in Charlotte, North Carolina.
See NAHRI’s Advocacy in Action: Commenting on Proposed Rules and The Importance of Accurate Revenue Code Selection white papers for additional information.
CMS is also proposing payment to outpatient hospital departments for non-opioid therapies. If this proposal is finalized, revenue integrity professionals need to ensure these Healthcare Common Procedure Coding System (HCPCS) codes are priced properly in their chargemaster, said NAHRI Advisory Board member Ronald Hirsch, MD, FACP, ACPA-C, CHRI, vice president of the regulations and education group at R1 RCM Inc., in Murray, Utah. They should also make sure clinical departments are accurately capturing the charges, he said.
NAHRI Advisory Board members also discussed proposals related to bundling observation services, packaging cell and gene therapies, and more.
A recording of the July Quarterly Call is available for NAHRI members here. Stream more past calls here. Listening to or presenting on Quarterly Calls award 1 CHRI CEU. Register now for our 2024 series of calls. If you would like to present on an upcoming call, please contact NAHRI at nahri@hcpro.com.