Blog, Reimbursement

Top Questions from the FY2023 OPPS Final Rule Summary Webinar

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Tim Powell

Looking for more information about FY2023 OPPS Final Rule? BESLER’s Senior Reimbursement Consultant Tim Powell answers your questions from the recent webinar. 

To watch Tim’s FY2023 OPPS Final Rule Webinar, click HERE


  1. Can you comment on the N95 mask bi-weekly pass-thru payment issue?

    For cost reporting periods beginning on or after January 1, 2023, CMS is allowing facilities to be reimbursed for the differential between NIOSH-approved domestically made N95 respirators and NIOSH-approved non-domestically made N95 respirators. A NIOSH-approved surgical N95 respirator is domestic if the respirator and all of its components are grown, reprocessed, reused, or produced in the United States verified through a written statement from the manufacturer. Any other NIOSH-approved surgical N95 respirators would be considered non-domestic. The facility will need to request a Bi-Weekly payment from their MAC who will estimate the initial cost differential. See “CMS Table 50” from the CY 2023 OPPS Proposed Rule on second tab for an example of the calculation.

  2. What is the status of PAYGO an automatic 4% reduction in reimbursement?

    The Omnibus spending bill Congress passed on December 23, 2022 delayed the “Statutory PAYGO” provisions through the end of 2024.

  3. Do hospitals need to maintain the consent for donation in our records?

    Yes, we recommend that the harvesting facility or OPO maintain a copy of the “Consent to Donate” in their records for Medicare auditing purposes if the harvesting facility or OPO claims costs for maintaining organ viability on their Medicare cost report.

  4. Does the partial hospitalization program for telehealth apply to hospital at home?

    No that was specifically excluded.

  5. Is that monthly facility fee the same for all hospitals applicable?

    For REH, it is a single flat fee paid monthly.

  6. Will CMS continue to use Status K and G. How will we know whether to send JG or TB?

    While the dust has not settled, it would appear reasonable to bill all claims as TB pending clarification.

  7. Is drug reimbursement different at a REH?

    Separately billable drugs will outside of OPPS will be paid at the fee screen rate.

  8. CMS is requesting information regarding the Medicare organs recovered/excised and whether they will count as Medicare organs. When is the deadline to send that information?

    CMS usually allows 60 days after publication for public comment per the Paperwork Reduction Act of 1995.

  9. There was mention of JG Modifier but not TB Modifier. Is CMS doing away with it?

    While the dust has not settled, it would appear reasonable to bill all claims as TB pending clarification.


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