HCPro.com: Briefings on APCs

Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules and how they impact hospital health information management systems and processes, coding, billing, and reimbursement.

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May 2008 (Volume 9, Issue 5)	view entire issue

RAC report casts spotlight on wrong patient settings
Hospitals nationwide are taking notice of the Recovery Audit Contractor (RAC) program and the 2007 RAC status report, released February 28 by CMS. The report announced that CMS identified $371.5 million in improper Medicare payments collected from or repaid to healthcare providers and suppliers in California, Florida, and New York. Other states, including Massachusetts, South Carolina, and Arizona, are now subject to RAC audits, and the program will be rolled out nationally by January 1, 2010.

New information for ED trauma coding and charge capture creates confusion
New CMS guidance regarding services included in critical care CPT codes-codes that were commonly believed to be separately billable by the facility-has brought uncertainty to EDs nationwide. HIM directors and outpatient coding staff members must change their approaches to trauma and critical care coding and scrutinize more than seven years of potential noncompliance.

Wound care coding and billing: Address compliance risks
Lingering coding and billing difficulties, 2008 CPT/HCPCS changes, and OIG scrutiny promise to keep facility-based outpatient wound care coding and billing staff members on their toes. Develop an action plan to make the necessary changes to your internal policies, procedures, and chargemaster, then educate and audit to ensure revenue optimization and compliance success. "You need to be educating and auditing regarding your hospital outpatient wound care services," said Gloryanne Bryant, BS, RHIA, RHIT, CCS, senior director of systemwide coding HIM compliance at Catholic Healthcare West in San Francisco. Bryant spoke during HCPro's February 19 audioconference, "OPPS Wound Care Coding: Answers to Your Toughest Questions."

CMS releases an improved Advance Beneficiary Notice
In a much anticipated move, CMS released its new Advance Beneficiary Notice (ABN) of Noncoverage March 3. Hospitals must use this form (also known as the ABN-R-131) for all Medicare Part B provider and supplier services. The form replaces the existing ABN-G and ABN-L forms, and hospitals may also use it for voluntary notifications in place of the Notice of Exclusion from Medicare Benefits (NEMB). It does not replace the SNFABN-G form, which is currently under development.

CMS discusses new Medically Unlikely Edits, inpatient versus observation status during recent ODF call
CMS hosted its most recent hospital Open Door Forum (ODF) call March 13 in which it addressed several topics related to outpatient hospital services, including the new Advance Beneficiary Notice (ABN) of Noncoverage, National Provider Identifier (NPI), as well as questions from providers about self-administered drug billing, Medically Unlikely Edits (MUE), and more. Following is a summary of the call.

Other recently-published articles from Briefings on APCs:

Coder vs. biller: Does this match have a referee?

Q&A: Experts tackle billing for implantable devices

Report modifier -JW for discarded amounts of single-use drugs and biologicals: CAP participants excluded

Keep up to date on these important CMS transmittals

Documentation improvement: Take a team approach

Implement the new ESA transmittals in your hospital

Medically unlikely edits remain a puzzle to providers

OPPS packaging: Addressing CMS’ expansion and assessing the financial effect on your facility

Scheduled versus unscheduled ED care still confusing

Tune E/M documentation to meet the 2008 guidelines

RAC report casts spotlight on wrong-setting errors

CMS discusses new Medically Unlikely Edits, inpatient versus observation status during recent ODF call

CMS releases an improved Advance Beneficiary Notice

Wound care coding and billing: Address compliance risks

New information for ED trauma coding and charge capture creates confusion

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