Friday,
August 15, 2003
Vol. 6, No. 65
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Solve all of your biggest challenges-AUDITING, KICKBACKS, STARK, HIPAA,TRAINING, AND MEASURING EFFECTIVENESS with reporters who get the stories and ideas you need to comply and help your organization's bottom line!
"Strategies for Health Care Compliance," a 12-page monthly newsletter, helps you thrive in the ever-changing compliance environment by providing easy-to-understand compliance advice and analysis of the latest regulations. Each month, this newsletter offers how-to tips, features about your peers, policies and procedures, and tools for improving the efficiency and effectiveness of your corporate compliance programs. To learn more, click here or
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On Complianceinfo.com
Sample compliance policies and procedures. (For subscribers to Strategies for Health Care Compliance only)
Sample audit programs. (For subscribers to Health Care Auditing Strategies only)
The OIG Work Plan for Fiscal Year 2003
Ask the Expert
Compliance Hot Topics: Billing and Coding, EMTALA, Stark, HIPAA
Question of the Week
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Welcome to Compliance Monitor Q&A!
Our mission is to answer your difficult compliance questions-and your simple ones, too. To submit a question, send it to Compliance Monitor Q & A editor Melissa Osborn at mosborn@hcpro.com.
We hope you enjoy this service and we welcome your feedback.
This week's questions
Pay-per-view article
Quick survey
Questions and Answers
Will Medicare pay for routine observations?
Q:
Should I code observations admitted from an ancillary service (such as ambulatory surgery center) if the doctor does not give the reason for the admittance to observation?
A:
No, Medicare will not pay for routine observation following a surgical procedure. This service is usually packaged with the procedure payment. If a patient requires additional postoperative monitoring once the patient is discharged from the recovery room, the hospital should bill the services as a second stage recovery and assign the charges to 710, the recovery room revenue code.
The second stage charges will be packaged except for services such as postoperative injections (intramuscular, subcutaneous, IV, etc.), which will generate a separate payment when they are billed.
To charge and code for observation, the patient must meet strict diagnosis, documentation, time, and service criteria. Refer to program memorandum (PM) A-02-026 and A-02-129 for these guidelines. For criteria for observation that does not meet separate ambulatory payment classification (APC) guidelines--but still is allowable under Medicare guidelines to be billed as packaged services--refer to PM A-01-9.
This question and answer is brought to you by the APC Answer Letter. APC Answer Letter, a 16-page print publication filled with APC coding solutions, provides guidance and support for our readers. Designed in a handy eight by five inch reader-friendly format, the newsletter contains questions and answers concerning many issues surrounding APCs. Its advisory board is led by Jugna Shah, president of Nimitt Consulting of St. Paul, MN, and Frank Freeze, LPN, CCS, CPC-H, principal of The Wellington Group of Valley View, OH. They review questions from readers, and collaborate with a team of APC advisors to develop answers to those questions that keep readers on course. For more information or to order, Click here.
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Do your joint ventures meet the letter of the law?
The Office of Inspector General (OIG) is taking a hard look at joint ventures in health care that violate the letter of law by benefiting one side of the venture, or only a few physicians. Join us for "Physician/Hospital Joint Ventures: How to Achieve Compliant, Beneficial Joint Ventures," a live 90-minute audioconference on Wednesday, September 3. You'll learn to develop legal, compliant joint ventures that are in compliance with OIG guidelines and appropriately benefit hospital profits, patients, physicians.
To register or to learn more, click here or call our customer service department at 800/650-6787. Be sure to mention source code EZ1653E.
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New ezine: Health Care Auditing Weekly
Setting up and maintaining an auditing program is never an easy task, but HCPro now offers a free resource that delivers helpful news and advice each week!
Introducing Health Care Auditing Weekly, the new e-mail newsletter designed for healthcare internal auditors and compliance professionals. Click here to sign up for your complimentary subscription.
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Pay-Per-View article:
Fraud settlement prompted facility to add more audits and reviews
It was 2001, and four medical schools in the University of California (UC) Health System settled with the government for $22.5 million. The settlement came as a result of a Department of Justice (DOJ) audit of physicians at teaching hospitals, or PATH. At the time, administrators there knew that more comprehensive coding compliance audits were in order.
Go to "Fraud settlement prompted facility to add more audits and reviews" for the rest of this article. The cost is $10. Subscribers to the online version of Health Care Auditing Strategies have free access to this article. Subscribers to the print edition can find it in their August issues.
A $30 steal!
You can read this article-and much more-in the August issue of Health Care Auditing Strategies. Your cost: Five stories for only $30! You'll also learn how to audit observation services, how to perform a marketing audit, how to assess your clinical trials, and how to use aggressive mammography audits to boost detection and cancer analysis.
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Here's an audioconference that explains the challenges of clinical trials informed consent
In today's fast-evolving regulatory climate, investigators, research staff, sponsors, and patients considering involvement in clinical trials face a multitude of real and perceived challenges. The act of balancing regulatory compliance, institutional review board expectations, and subjects' right to informed participation is difficult at best.
Join us for "The Challenge of Informed Consent in Clinical Trials: Practical Examples and Expert Advice" on Thursday, September 4 beginning at 1 p.m. Eastern. You'll learn to identify the particular challenges in informed consent and to work positively and prospectively with your IRB to manage those concerns.
To learn more or to register, click here or call our customer service department at 800/650-6787. Be sure to mention source code EZ1663D.
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Can we bill patients for multiple copayments?
Q:
Can we bill patients for multiple copayments when they receive several treatments in a single day?
A: To read the answer to this question, click here.
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Quick survey:
How difficult do you find it to structure compliant physician recruitment arrangements?
To submit your answer, go to the Question of the Week at
Complianceinfo.com.
Here are the answers to the last survey:
When will your organization begin auditing its HIPAA compliance program?
- Within the next six months: 74%
- In 7-12 months: 13%
- In 12+ months: 9%
- We do not plan to audit: 4%
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Network with your audit colleagues
"Audit Talk" is a new, moderated chat forum that members can use to post messages or questions for their peers 24-hours-a-day. "Audit Talk" offers a free forum to network, share ideas, and solve problems for those in the audit industry. Getting involved is easy. To subscribe, just send your request to this e-mail: owner-audit_talk@hcpro.com.
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Share the news!
You've been benefiting from our informative
e-mail newsletter, so why not pass on this resource to your peers? Sign up a colleague and get $20 off your next purchase on HCPro's Healthcare Marketplace!
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Send your comments and questions about Compliance Monitor Q&A to:
Melissa Osborn
Managing Editor
mosborn@hcpro.com
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