The FY2023 Inpatient Prospective Payment System (IPPS) Final Rule was published in the Federal Register and is effective October 1, 2022.
NTAP is considered for new services or technologies when:
- they are new and not substantially similar to other existing services or technology;
- the services or technology is more costly or the MS-DRG payment is inadequate for coverage of the new technology;
- the service or technology demonstrates substantial clinical improvements over existing services or technology with the exception of certain antimicrobials which have been approved under the Limited Population Pathway for Antibacterial and Antifungal Drugs (LPAD) and are authorized by the FDA as a Qualified Infectious Disease Product (QIDP).
- NTAP without QIDP designation is equal to the lesser of 65% of the cost of the new technology or 65% of the amount by which the cost exceeds the standard DRG payment.
- NTAP with QIDP designation or approved under the FDA’s LPAD pathway is equal to the lesser of 75% of the costs of the new medical service technology or 75% of the amount by which the costs of the case exceed the standard DRG payment.
The New Technology Add-on Payment (NTAP) for Inpatient Claims (FY2023) Tool provided by Visante Pharmacy Revenue Cycle Team has been updated to reflect the FY23 changes that impact the drugs and biologicals. The crosswalk contains the newness start date, NTAP status, maximum NTAP payment and the associated ICD-10-PCS codes.
- Pharmacy and HIM/Coding teams should collaborate to ensure that the system is updated for proper capture and application of the ICD-10-PCS codes to the claim. Without the ICD-10-PCS code, the claim will not process the NTAP payment.
- Pharmacy teams should take into consideration NTAP payment in formulary decision-making, but note these payments only last for 2 to 3 years.
Our goal is simple; we’re taking complex information and making it practical.
Until our next edition, this is Maxie Friemel and Agatha Nolen providing you with tips for increasing your Pharmacy Revenue Cycle.