BWC OPPS To Start Jan. 1, 2011
July 1, 2010:
The Ohio Bureau of Workers' Compensation will start a Medicare-based, hospital outpatient prospective payment system (OPPS) Jan. 1, 2011. In a revised version of OAC 54123-6-37.2 , BWC outlines the state-fund OPPS rules. BWC also has a comparative overview of the Medicare and BWC OPPS' available.
From Jan. 1, 2011, through March 31, 2012, BWC will pay acute care hospitals 197 percent of what Medicare pays for the same outpatient service and 253 percent of the Medicare rate at childrens hospitals. Critical Access Hospitals are exempt. For the first quarter of calendar year (CY) 2011, BWC will use Medicare's 2010 OPPS pricing and grouping methodology. Effective April 1, 2011, BWC will adopt Medicare's CY 2011 version. Thereafter, annual updates to the BWC OPPS will occur on April 1.
In the second year of BWC's transition to its OPPS -- April 1, 2012, through March 31, 2013 -- BWC will pay acute care hospitals 181 percent of what Medicare pays for the same service and pay childrens hospitals 253 percent of what Medicare pays. After April 1, 2013, the acute care rate will drop to 166 percent of what Medicare pays, while childrens hospitals will stay at 253 percent.
The revised BWC state-fund OPPS has no direct effect on self-insured employers, but other BWC rules give them the right to adopt the state-fund methodology if they choose.
BWC is working with OHA member hospitals on testing and OHA's Finance and Admitting, Billing & Collection Committees will continue to meet with BWC over the summer and fall on the transition.
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