Provider Roundtable Formed in 2003

CMS has often said it wants more comments from providers as it develops the annual Medicare rule. Providers’ comments about the day-to-day operational issues that hospitals face are unique and powerful, and could result in significant improvements to the OPPS system. While many people working in the OPPS/APC field would like to share their concerns with CMS, hospital staff face enormous constraints in terms of both time and resources. These key stakeholders often are unable to share their experiences and suggestions with CMS, or are unsure how to do so. 

Nimitt Consulting realized providers needed support and encouragement in order to communicate more often with CMS. So, in 2003, Nimitt Consulting created the Provider Roundtable with the support of 3M HIS, and HCPro. 

The Provider Roundtable is a forum that gives professionals both the time and resources they need to communicate with CMS on critical issues. The Provider Roundtable brings together a nation-wide group of hospital representatives who are implementing and managing OPPS and APCs in a variety of settings. These professionals deal with OPPS and APCs every day, and have important information to share with CMS. 

Who Serves on the Provider Roundtable?

Representatives of the Provider Roundtable work in the APC/OPPS environment every day. They come from health information management, business offices, patient accounting, clinical and ancillary departments, information systems, and finance.

The Roundtable brings these experienced individuals together with Sponsors from the consulting, software, and publishing efforts on OPPS/APC. The result will be a unique exchange of information, ideas, and pertinent comments for CMS. The Roundtable provides an opportunity for peers from across the country to work together and share experiences around OPPS and APC issues. Most importantly, the process will help CMS shape the OPPS and APC system and improve it in the future.

• Downloadable list of PRT members and their affiliations as of September, 2011
  PDF document, 13K
• Member photos

What is the Provider Roundtable?

The Provider Roundtable is an ambitious project sponsored by Nimitt Consulting, 3M Health Information Systems (HIS), and HCPro, Inc. The forum unites hospital representatives implementing and managing OPPS and APCs across the country. The voices of front-line professionals who are dealing with OPPS and APCs should be the loudest when CMS makes changes to the system. Yet, because hospital staff face enormous constraints in terms of time and resources, these key stakeholders often aren’t able to share their experiences and suggestions with CMS.

In response to the many professionals who want to give feedback to CMS about ways to improve OPPS/APCS, Nimitt Consulting Inc. created the Provider Roundtable in 2003. This ambitious project, also sponsored by HCPro and 3M Health Information Systems (HIS), creates a forum to unite the voices of hospital representatives involved in implementing and managing OPPS and APCs across the country. This forum enables the provider community to come together as a group and speak to CMS on critical OPPS and APC issues through written comments and oral testimony.

What has the Provider Roundtable done? 

The Provider Roundtable has submitted comments to CMS on OPPS proposed rules from 2004 through 2012. The group meets face-to-face to draft positions on the rule and submits detailed comments on numerous issues raised in the rule. CMS has listened to many of the PRT’s recommendations over the years. PRT members were especially pleased to see that CMS listened to recent comments provided on appropriate APC assignment and payment for CPT codes 74176 — 74178 which were not “new services” in CY 2011, only newly released CPT codes for reporting CT of the abdomen and pelvis when provided in together during the same session. These codes describe a combination of services previously reported with two CPT codes, but now reported with one code. CMS’ proposal for CY 2012 validates the PRT and other organizations’ views on appropriate APC payment. The PRT was pleased to see CMS’ proposal that predecessor CPT code claims data should be used to set the payment rate for newly created codes when available.

The PRT also routinely provides testimony to the APC Advisory Panel on issues such as the separately payable observation APC, packaging, packaged revenue codes, the inpatient-only list, drug administration, use of HCPCS codes for evaluation and management services, appropriate rate-setting for new combination CPT codes, and much more.

To read more about the Provider Roundtable’s activities, see below.

• Provider Roundtable’s Comments on the 2012 proposed OPPS rule  PDF document, 190K

• Provider Roundtable’s Comments on the 2011 proposed OPPS rule  PDF document, 109K

• Provider Roundtable’s Comments on the 2010 proposed OPPS rule  PDF document, 106K

• Provider Roundtable’s Comments on the 2009 proposed OPPS rule  PDF document, 106K

• Provider Roundtable’s Comments on the 2008 proposed OPPS rule PDF document, 180K

• Provider Roundtable’s Comments on the 2007 proposed OPPS rule  PDF document, 346K

• Provider Roundtable’s Comments on the 2006 proposed OPPS rule PDF document, 60K
• Provider Roundtable’s Comments on the 2005 proposed OPPS rule PDF document, 367K
  • Appendix A: Provider Roundtable Members 
    PDF document, 20k
• Provider Roundtable’s Comments on the 2004 proposed OPPS rule PDF document, 178K
  • Appendix A: Provider Roundtable Members
    PDF document, 56K
  • Appendix B: Per-Unit Blood Costs
    Excel (XLS) document, 28K
  • Appendix C: Modifications Submitted by Members of the Provider Roundtable
    PDF document, 194K
• HCPRO article on the 2003 Provider Roundtable comments and results