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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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Briefings on APCs

Issue 12, December 1, 2003 - VIEW THE FULL ISSUE

• OPPS 2004 final rule puts financial squeeze on rural hospitals

  If you are operating a rural hospital with 100 or fewer beds, get ready for a tough year. The 2004...

• Provider Roundtable gives CMS feedback, gets results in return

  CMS asked for provider feedback on the proposed 2004 OPPS rule and that is exactly what it got from...

• 2004 CPT code book and 2004 OPPS final rule update modifier guidelines

  It's time to prepare for the 2004 and its new codes and modifier guidelines. Lolita M. Jones, RHIA...

• The final rule: Not as hard to live with as we thought it would be

  Editor's note: Jugna Shah, MPH, president of Nimitt Consulting, Inc., in St. Paul, MN, authors...

Issue 11, November 1, 2003 - VIEW THE FULL ISSUE

• Prepare for OPPS changes with in-house impact analysis

  Large or small, rural or urban, every hospital has the same question when it comes to new...

• Preventive medicine approach decreases OCE edits

  When Janet Burt, RHIT, took the APC coordinator position at St. Joseph's Hospital in Reading, PA...

• Real-life coding: Using bilateral modifier -50 correctly for urology surgery

  Editor's note: BAPC and Lolita M. Jones, RHIA, CCS, of Lolita M. Jones Consulting in Fort...

Issue 10, October 1, 2003 - VIEW THE FULL ISSUE

• Be ready for E/M guidelines

  Editor's note: At presstime, CMS had yet to announce whether it would move forward with the E/M...

• Cope with the loss of corridor payments by improving revenue

  The expiration of transitional corridor payments in 2004 may have a huge impact on bottom lines for...

• Don't sit back and wait for new E/M guidelines

  When the new E/M level guidelines are announced, all EDs will have a set of rules they can follow...

• Create a query policy to streamline process

  In the fast-paced atmosphere of health care, when a coder has to stop to ask a physician for more...

Issue 9, September 1, 2003 - VIEW THE FULL ISSUE

• Proposed OPPS rule changes point toward lost revenue

  The pricing of pass-through drugs could fluctuate in the wrong direction for hospitals and drug...

• Conflicting information about CCI edits pushes decisions onto coders

  CCI edits are applied to services billed by the same facility for the same patient on the same date...

• CMS doesn't 'disappoint': Proposed 2004 OPPS rule could have massive impact

  "OPPS Advisor" is written by Jugna Shah, MPH, president of Nimitt Consulting, Inc., in St. Paul...

• Real-life coding: Find the modifier mistakes in 10 audit cases

  Test your skills with this actual coding scenario Editor's note: BAPCs and Lolita M. Jones...

Issue 8, August 1, 2003 - VIEW THE FULL ISSUE

• Proposed E/M guidelines bring promise with potential pain

  E/M facility levels have been the plague of outpatient facilities and departments for three years...

• Bill endoscopies correctly

  Many facilities across the country bill an endoscopy procedure as a bundled charge, instead of as...

• Coding in real life: Modifier -25

  BAPCs and Lolita M. Jones, RHIA, CCS, of Lolita M. Jones Consulting in Fort Washington, MD, bring...

Issue 7, July 1, 2003 - VIEW THE FULL ISSUE

• Garbage in = garbage out

  The only way to get clean claims and the reimbursement you deserve is to put accurate information...

• Use historical ED data to determine where you are losing money and why

  From the moment a patient steps into an ED until the final bill for the visit has been processed...

• Your CDM needs these July changes

  The good news about the July OCE and OPPS coding and billing updates is that most of the changes...

• Coding in real life: Choose the right repeat-procedure modifier

  BAPCs and Lolita M. Jones, RHIA, CCS, of Lolita M. Jones Consulting in Fort Washington, MD, bring...

• FI policies differ on Q0081 with chemotherapy

  Whether you can code both Q0084 and Q0081 for a patient in an outpatient infusion center with a...

Issue 6, June 1, 2003 - VIEW THE FULL ISSUE

• Stop bleeding from your ED

  Every time your ED doors swing open for a patient, potential facility revenue could be flying right...

• Training billing staff crucial to an efficient revenue cycle

  There can be more than a dozen departments involved in the revenue cycle process, but training the...

• Create clean claims with proper mammography coding

  Mammography claims are one of the types more frequently denied by fiscal intermediaries and other...

• Coding in real life: Will modifier -59 help?

  Test your skills with this actual coding scenario BAPCs and Lolita M. Jones, RHIA, CCS, of...

Issue 5, May 1, 2003 - VIEW THE FULL ISSUE

• April PMs bring more changes

  Program Memorandum (PM) A-03-020 announces new codes, pass-through devices and drugs, plus changes...

• Don't let infusions and injections needle you out of money

  The payment rate for injections and infusions may not be large, but they occur in the outpatient...

• Code the intended anesthesia for discontinued interventional radiology procedure

  When an interventional radiology procedure is aborted or discontinued before anesthesia is...

• Develop a form and review claims before submission to ensure maximum reimburseme

  Documentation for observation service is key for proper reimbursement and keeping your facility out...

• The bane of bunion coding: Too many codes to choose from

  One simple diagnosis-bunions-can involve one of nearly a dozen CPT procedure codes. Coders need to...

Issue 4, April 1, 2003 - VIEW THE FULL ISSUE

• Hospitals stand to lose revenue with drug-eluting stents

  When the Food and Drug Administration (FDA) approves the use of drug-eluting stents, coronary...

• Is the final rule finally final? Don't count on it just yet

  CMS once again tinkered with the 2003 final rule, correcting miscalculations, typographical...

• Outpatient outlier review is inevitable

  Outpatient billing department staffs probably heaved a sigh of relief earlier this year when CMS...

• Case study: Test your skills at coding aborted and completed procedures

  Lolita M. Jones, RHIA, CCS, of Lolita Jones Consulting in Fort Washington, MD, presents you with...

• Navigate the ins and outs of wound repair with these reference tools

  There are far too many variables in coding wound repair to remember them all, says Tiffany...

Issue 3, March 1, 2003 - VIEW THE FULL ISSUE

• New modifier indicates inpatient procedure provided to outpatient

  Over the past year, hospitals and hospital associations have asked how to receive Medicare payment...

• Regular audits determine accuracy of billing and coding

  Conducting an APC audit ensures that your organization identifies, monitors, and rectifies...

• Hospitals not enjoying benefits promised under OPPS

  Despite assurances that OPPS would save beneficiaries money, ensure more accurate payments under...

• Observation miscoding can cost you

  Coding mistakes, however innocent, can make your facility a target for an audit by the Office of...

• Coding Coach: Know your modifiers

  The correct use of modifiers is extremely important in order to avoid the risk of fraud and abuse...

Issue 2, February 1, 2003 - VIEW THE FULL ISSUE

Issue 1, January 1, 2003 - VIEW THE FULL ISSUE

Issue 2, February 21, 2003

• Coding and billing go hand in hand more than ever

  By Glenn Krauss, RHIA, CCS, CCS-PCoding and billing are essential components of the...

• Coding Coach: Complexity of shoulder makes coding difficult

  The shoulder is a complicated structure of bones, joints, ligaments, muscles, and...

• New G-code ends one modifier -59 headache

  Outpatient arthroscopic knee surgery—when it entails two procedures in different...

• New PMs include many changes to final rule

  Jugna Shah, MPH, President of Nimitt Consulting Inc. in St. Paul writes “OPPS...

• Survey shows charging and coding procedures vary widely among ED staff

  Designing a procedure for coding and charging ED records can be a daunting task, because there...

Issue 1, January 21, 2003

• Experts examine financial, clinical impacts of new rule

  The 2003 OPPS final rule affects all sides of the health care industry. In a recent...

• Grace periods for new codes vary

  The three-month grace period that normally comes with annual code changes will not apply to...

• Read between the lines: decipher between actions and words

  Editor’s note: In the October 2002 issue of BAPCs, Glenn Krauss, RHIA, CCS, senior...

• Staying up to code on changes in 2003 CPT code book

  The CPT code book, updated annually by the American Medical Association (AMA), includes several...