Determining Eligibility within Hospitals
folder_openInformation for HOPDs / ASCscalendar_todayPosted July 7, 2016

The Centers for Medicare & Medicaid Services (CMS) and the OAS CAHPS Survey Coordination Team would like to share updated guidance to determining eligibility for the OAS CAHPS Survey within hospitals.

Medicare-certified hospitals are eligible to participate in the OAS CAHPS survey if they meet all of the following criteria:

• The hospital has one or more hospital outpatient surgery departments or other specialized departments that perform outpatient procedures and surgeries.
• These departments perform procedures that are within the OAS CAHPS-eligible range of CPT-4 Codes for Surgery (i.e. CPT codes between 10021- 69990) or one of the following G-codes: G0104, G0105, G0121 or G0260.
• These departments bill under the Outpatient Payment Prospective System (OPPS).
• The OAS CAHPS-eligible procedures performed within the department are performed by a doctor (not a technician).
• The OAS CAHPS-eligible procedures are not performed in an office setting (doctor’s office) or the emergency department.

These criteria are intended to ensure that OAS CAHPS surgeries and procedures are not overlapping with any other CAHPS Surveys such as Hospital CAHPS, Clinician & Group CAHPS or Emergency Department CAHPS.

Additionally, units that meet the above criteria that are within critical access hospitals (CAHs) are also eligible to participate in the OAS CAHPS Survey even though CAHs do not bill under OPPS.

Note that this new guidance supersedes the previous definition of eligible hospital outpatient departments (HOPDs), as eligible HOPDs are not the only units in the hospital where OAS CAHPS-eligible procedures or surgeries are performed. Also eligible departments do not have to have outpatient surgery as their primary focus. The clarification provided in this announcement will be included in the next version of the Protocols and Guidance Manual.

Please contact the OAS CAHPS Survey Coordination Team via e-mail at oascahps@rti.org or call toll-free (866) 590-7468 if you have any questions about determining eligibility within hospitals.