Freestanding Emergency Department Discharge Data Reporting – OPPS Final Rule, CY 2019
MedPAC’s June 2017 Report to Congress states that there has been significant growth recently in the number of health care facilities located apart from hospitals that are devoted primarily to emergency department services; including both OPPS-eligible off-campus provider-based emergency departments and OPPS-ineligible freestanding emergency departments not affiliated with a hospital.
In order to track this, CMS is, through subregulatory process, requiring that effective January 1, 2019, a HCPCS modifier “ER” (items and services furnished by a provider-based off-campus emergency department) be reported with every claim line for outpatient hospital services furnished in an off-campus provider-based emergency department. The modifier would be reported in the UB-04 form for hospital outpatient services.
Summary:
- Significant growth in the number of EDs and volume of services in off-campus EDs.
- CMS must collect data to assess the extent to which services are shifting to off-campus EDs.
- Effective 1/1/2019, modifier, ER, will be required with every claim line for outpatient hospital services furnished in off-campus, provider-based EDs.
Please make the necessary changes to comply with this requirement effective January 1, 2019. THA will analyze the data throughout 2019 and assess the usage of this new modifier, ER, for freestanding EDs. NOTE: As a THA-HIN member, you must continue to report your freestanding ED data to us, at this time, using bill type 078X.