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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June 2008 (Volume 9, Issue 6)	view entire issue

Medically unlikely edits remain a puzzle to providers
Earlier this year, CMS advised that the medically unlikely edit (MUE) value for units with CPT infusion codes 90766 or 90761, billed to FIs, would be increased on April 1, retroactive to the original date of January 1. However, not until the end of April did providers begin to notice infusion and injection claims being accepted for values that had previously been rejected, whereas reports of other MUEs appeared in the April Open Door Forum (ODF).

RAC report casts spotlight on wrong-setting errors
Editor's note: The first article in this two-part series appeared in the May BAPCs. It discussed ways that your facility can prepare for audit under the recovery audit contractor (RAC) program. RACs have collected huge sums simply by comparing one-day stays with InterQual criteria, a set of measurable clinical indicators that reflect a patient's need for hospitalization, says Marion Kruse, RN, MBA, a consultant at FTI Consulting in Atlanta. When these stays did not meet InterQual guidelines, RACs requested a repayment.

Tune E/M documentation to meet the 2008 guidelines
The 2008 OPPS final rule challenges outpatient facilities to be more exact than ever regarding documentation and coding. This is nowhere more true than in the E/M process. Hospitals run into difficulty putting the rule into practice, shedding some cherished but inaccurate beliefs about documentation best practices, and widening the circle of responsibility for documentation improvement.

Scheduled versus unscheduled ED care still confusing
Questions from the March 18 HCPro audioconference, "Facility E/M Update: Meet CMS' Latest Coding and Documentation Requirements," indicate that, operationally, facilities still struggle with scheduled visits in the ED. The topic is a recurring problem because many in the provider community don't understand which types of services constitute scheduled care in an ED.

OPPS packaging: Addressing CMS' expansion and assessing the financial effect on your facility
With the release of the 2008 OPPS final rule, CMS took drastic steps toward more aggressive packaging of services. Hospitals should analyze the new policies and concepts in the rule and prepare for similar changes in the future. "CMS has started down a road to significant packaging," said Jugna Shah, MPH, president of Nimitt Consulting in Washington, DC, who spoke during HCPro's February 14 audioconference, "OPPS Packaging: Financial and Coding Implications of CMS' Drastic Change."

Other recently-published articles from Briefings on APCs:

CMS releases 2009 OPPS final rule; trends continue

CMS issues annual HCPCS update for 2009

New year brings more than 500 CPT changes

CMS Hospital Open Door Forum

Medicare proposes revised coverage policy for bariatric surgery as a diabetes treatment

Briefings on APCs 2008 index

Make determinations for self-administered drugs

Advisory panel speaks out against proposed decrease in separately payable drug reimbursement for 2009

October Open Door Forum

Medicare publishes most Medically Unlikely Editsts

ICD-10 implementation timetable draws fire and support

Opinions vary on proposed payment changes to Type B EDs

Decipher integumentary codes for correct coding

Make determinations for self-administered drugs

Reminder: Medicare covers diabetes screening

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