HCPro.com: APC Payment Insider

APC Payment Insider reports on the latest coding and policy changes affecting Medicare outpatient billing under ambulatory payment classifications (APCs). This monthly newsletter offers proven strategies to succeed under CMS's outpatient prospective payment system (OPPS), plus ways to enhance chargemaster maintenance, recruit and retain qualified coders, speed billing turnaround, improve documentation habits, and use modifiers properly.

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July 2008 (Volume 10, Issue 7)	view entire issue

RAC report casts spotlight on wrong-setting errors
Recovery audit contractors (RAC) 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.

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 April 1, retroactive to 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).

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 especially true for 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.

Infusions
Editor's note: The following questions were answered by Cindy Basham, MHA, RN, CPC, CCS, senior regulatory specialist at HCPro, Inc., in Marblehead, MA.

Other recently-published articles from APC Payment Insider:

CMS proposes five new composite APCs, reduces drug reimbursement

Prefabricated splint codes: No easy answers

Unraveling the costly inpatient-only procedures puzzle

Implement the new ESA transmittals in your hospital

Infusions

Tune E/M documentation to meet the 2008 guidelines

Medically unlikely edits remain a puzzle to providers

RAC report casts spotlight on wrong-setting errors

RAC report casts spotlight on wrong-patient settings

Injections and infusions

Billing for packaged drugs: Meet coverage requirements

Digest the new mandatory reporting requirements for ESA administration as of April 7

Charge appropriately for radiopharmaceuticals in 2008

CMS publishes shocking FAQ about critical care information on its site

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