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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July 2008 (Volume 9, Issue 7)	view entire issue

Implement the new ESA transmittals in your hospital
Editor's note: This is the first article in a two-part series. In January, CMS published three transmittals (Transmittals 1412, 1413, and 80) that significantly changed the process of billing for erythropoietin-stimulating agents (ESA). As noted in the March Briefings on APCs, hospitals that treat end-stage renal disease know these guidelines, but other facilities may find them difficult to implement. An April 10 HCPro, Inc., audioconference, "New ESA Transmittals: Train Your Staff on Coverage Coding and Billing Guidelines," addressed this problem.

Documentation improvement: Take a team approach
Editor's note: In the June Briefings on APCs, "Tune your E/M documentation to meet guidelines" discussed the OPPS final rule's 11 guidelines and problem areas in E/M coding. The article was based on the March 18 HCPro, Inc., audioconference, "Facility E/M Update: Meet CMS' Latest Coding and Documentation Requirements." The following article, based on the same audioconference, discusses additional ways to improve E/M effectiveness.

Keep up to date on these important CMS transmittals
Editor's note: A summary of the April CMS I/OCE update-Transmittal 1483-appeared in the June Briefings on APCs. This article describes a subsequent CMS transmittal closely related to the primary I/OCE update. April OPPS update On April 8, CMS issued Transmittal 1487. The transmittal describes changes to, and billing instructions for, various payment policies implemented in the April OPPS update.

Report modifier -JW for discarded amounts of single-use drugs and biologicals: CAP participants excluded
Providers should report modifier -JW ("Drug or biological amount discarded/not administered to any patient") when processing certain types of drugs to receive payment for partial use of those drugs, according to Transmittal 1478, which became effective April 14. According to the transmittal, CMS hopes the modifier will result in the most efficient possible use of biologicals and drugs. Report this modifier when a provider administers the patient part of a biological or drug from a single-use package or a single-use vial. Modifier -JW ensures payment for the portion the patient received and the portion discarded.

Q&A: Experts tackle billing for implantable devices
Editor's note: Kimberly Anderwood Hoy, Esq., JD, CPC, director of Medicare and compliance at HCPro, Inc., in Glen Allen, VA, and Hugh Aaron, MHA, JD, CPC, CPC-H, senior advisor at HCPro, in Marblehead, MA, answered the questions below.

Coder vs. biller: Does this match have a referee?
The subject can come up at any gathering of HIM professionals: the friction that can arise between billing and coding departments. Conversation about these conflicts has even reached the blogosphere. A thread on Advance's HEALTHCARE POV blog began with this classic example: I presently work in an acute hospital setting as an ED coder. Our billing department is constantly reviewing our dx codes (especially for Medicare/Medicaid) accounts, and they are always asking us to look for additional codes to add so that we can get payment. In fact, one biller in particular actually gets into our accounts and adds codes so that payment can be made.

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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