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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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Issue 12, December 1, 2006 - VIEW THE FULL ISSUE

• OIG watching new and old targets in 2007 Work Plan

  Like the all-seeing eye in J.R.R. Tolkien's The Lord of the Rings, the OIG has turned its expansive...

• The OIG to train its sights on hospital ED diagnostic x-rays

  Among the items in the recently released 2007 OIG Work Plan is a forthcoming audit of...

• Audit pharmacy charges to recover lost facility revenue

  Incorrect pharmacy charges and units of services are a frequent source of lost revenue for...

• ED service date issue rears its head during Open Door Forum

  CMS: Rule applies to E/M charge and all other services Establishing the proper service date for...

• AdminaStar observation FAQ creates controversy

  Advice not to bill infusion with observation corrected A frequently asked questions (FAQ...

• Ask the expert: Answers to thorny observation questions

  Last month, Valerie Rinkle, MPA, revenue cycle director for Asante Health System in Medford, OR...

Issue 11, November 1, 2006 - VIEW THE FULL ISSUE

• CMS presents E/M guidelines for national consideration

  In the 2007 OPPS proposed rule, CMS states that the three-level American Hospital Association...

• CMS appears to put kibosh on postoperative injections

  In terms of hotly debated OPPS coding/billing topics, there are few subjects that approach the...

• Ask the expert: Avoid observation stumbling blocks

  Proper coding and compliance requirements for observation patients continue to befuddle HIM/coding...

• Don't let recurring accounts make your head spin

  When outpatients make repeat visits to a hospital clinic setting (e.g., a wound care clinic) there...

• APC Advisory Panel issues recommendations to CMS on drug administration

  Eliminating the time requirement for critical care HCPCS codes, moving to CPT codes only for drug...

Issue 10, October 1, 2006 - VIEW THE FULL ISSUE

• 2007 OPPS proposed rule has plenty to digest

  Tentative steps toward national guidelines and new HCPCS codes/APC payments for E/M services, plus...

• CMS overhauls E/M in OPPS proposed rule

  Agency proposes new G codes/APC payments, possible use of AHA/AHIMA guidelines CMS did not...

• Consider this model to develop wound care clinic E/M levels

  New program directors of hospital-owned outpatient wound care departments (HOPD) often struggle...

• Prepare now for NPI deadline to avoid billing delays

  Although providers are not required to use the national provider identifier (NPI) numbers as the...

Issue 9, September 1, 2006 - VIEW THE FULL ISSUE

• Train your staff to use drug administration, other charge forms

  How one hospital uses nurses to improve its ED coding Developing new drug administration and...

• Experts answer difficult OPPS wound care charging/coding questions

  Wound care charging/coding and billing in the hospital outpatient setting can be difficult...

• Develop forms to improve your nursing documentation

  Editor's note: This is the second article in a three-part series about nursing documentation and...

• Decode these real-life modifier -74 hospital case studies

  If you make the mistake of not coding discontinued outpatient procedures, you may be leaving money...

Issue 8, August 1, 2006 - VIEW THE FULL ISSUE

• Bust these facility coding myths

  Even though the OPPS is in its sixth year, myths persist over whether you can assign codes and E/M...

• Price your chargemaster correctly to avoid compliance and legal risks

  Pricing services and supplies correctly in your chargemaster is vitally important to the financial...

• Experts answer your tough E/M coding questions

  Many large and small hospitals continue to struggle with which services to include in their E/M...

• Take careful note of nursing documentation

  Editor's note: This article is part one of a three-part series. This month, we examine the...

Issue 7, July 1, 2006 - VIEW THE FULL ISSUE

• Draft a policy to bill hospital supplies

  Consider billing rules, pricing, and more Medical coding and billing rules aren't always clear...

• Prepare now for arrival of the UB-04

  Although the transition period for the UB-04 claim form-which will replace the veteran UB-92-is...

• Attorneys answer coders' questions about legal issues

  Editor's note: The following is a sample of questions and answers from a session held during the...

• Clean up your modifier -50 claims with these techniques

  In this month's column, Lolita Jones, RHIA, CCS, of Lolita M. Jones Consulting in Fort Washington...

• Drug administration 'rejection relief' coming to hospitals

  Expect modifier -59 claims processing help from CMS, FIs, according to new article When CMS...

Issue 6, June 1, 2006 - VIEW THE FULL ISSUE

• Be a 'hospital Houdini' when auditing

  Tips, tricks, and tactics to fix outpatient problems Hospital outpatient services, charges, and...

• Drug administration NCCI edits may require heavy dose of modifier -59

  New CMS transmittal clarifies C8952 and more Hospitals nationwide learned the hard way that on...

• Apply modifier -25 correctly in wake of OIG audit

  Along with modifier -59, modifier -25 (significant, separately identifiable E/M service by the same...

• Change of diagnostic order? Make sure the claim gets paid

  Use these tips to ensure radiology compliance, payment of subsequent tests Hospital radiologists...

Issue 5, May 1, 2006 - VIEW THE FULL ISSUE

• How to define and bill critical care

  Editor's note: This is the second article in a two-part series about problematic ED coding. The...

• Avoid dispensing multiple-day take-home drugs to patients

  CMS makes DMERC billing a requirement Starting July 1, hospitals must bill their durable medical...

• Don't miss the new cardiac catheter reimbursements

  Cardiac catheterization is one of the more frequently reported CPT codes nationwide. With...

• Take a glimpse at possible 2007 APC/OPPS changes

  In 2007, hospitals may benefit from many potential billing and reimbursement changes. For example...

Issue 4, April 1, 2006 - VIEW THE FULL ISSUE

• New CMS guidance places stiff limit on drug administration code

  Report C8952 only once per encounter for same drug Hospitals can bill multiple units of new...

• Learn answers to your toughest ED facility coding questions

  Editor’s note: This is the first in a two-part series about coding difficult ED procedures...

• Learn updated definitions, coding guidelines to bill conscious sedation properly

  by William Malm, ND, RN Providers continue to struggle with how to define and bill conscious...

• Take the ache out of coding discontinued IR procedures

  Although CMS states that hospitals should report modifier -52 (reduced services) when radiology...

• New OPPS rules open the door for device payments

  Hospitals may see reimbursement for sinus surgery catheters, more Hospitals whose physicians...

Issue 3, March 1, 2006 - VIEW THE FULL ISSUE

• Consider using this effective E/M tool

  For the seventh consecutive year since the inception of APCs, CMS did not release national E/M...

• Inpatient, outpatient, or observation? Avoid denials with these strategies

  Consider the following scenario: A hospital transfers a patient in semi-urgent status to a second...

• Keep your hospital abreast of recent radiology changes

  As hospital outpatient radiology departments incorporate new technology, they must also adapt to...

• LCD appeals process can bring worthwhile results

  It’s a frustrating but common scenario for hospitals: CMS issues coding and billing...

• Prepare your hospital for modifier changes in final rule

  The 2006 OPPS final rule contained three modifier-related coding and billing changes that both...

Issue 2, February 1, 2006 - VIEW THE FULL ISSUE

• OIG sets its sights on familiar targets in 2006 Work Plan

  Hospital outpatient coding and billing staff should take a close look at some of the common...

• Try these four tips to improve your chargemaster’s accuracy

  The start of the new year is the best time to perform a top-to-bottom chargemaster audit, say John...

• Learn official guidelines for arterial stent placement

  The OIG recently released an audit report that showed how two providers inappropriately reported...

• Don’t overlook recent OIG audit of modifiers -25, -59

  Organization’s physician findings also apply to hospitals Modifiers -25 and -59, as used...

• OPPS Q&A: Experts answer readers’ coding questions

  Editor’s note: The following questions were answered by Jugna Shah, MPH, president of Nimitt...

Issue 1, January 6, 2006 - VIEW THE FULL ISSUE

• Update your systems for new skin codes, CVA payment rates, and more

  Last month in BAPCs, I presented a top 10 SWOT (Strengths, Weaknesses, Opportunities, and Threats...

• Try these tips to help solve the drug administration payer quandary

  It is unlikely that private payers will recognize the new Medicare drug administration HCPCS codes...

• How remote coding increased ED productivity by 30%

  South Shore Hospital’s coding department was at a crossroads in 2003. The hospital had been...

• Use modifier -58 to get paid for postsurgical procedures

  Are you being properly paid for postsurgical procedures? Using modifier -58 ensures that your...