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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, 2015 - VIEW THE FULL ISSUE

• NCCI logic could lead to no payment for claims including comprehensive APCs

  Providers need to be careful when reporting multiple services with status indicator J1 on the same...

• Making sense of modifier -PO

  Provider-based clinics and departments are increasingly common, but the rules for provider-based...

• Training tool: ICD-10-CM coding quiz for cardiac conditions

  Use this 10-question quiz to determine how well you understand ICD-10-CM coding for cardiac...

• This Month's Coding Q&A

  Our coding experts answer questions about cataract surgery, order authentication, and more. 

Issue 11, November 1, 2015 - VIEW THE FULL ISSUE

• Beware of the limitations of GEMs

  After years of delays, industry and legislative pushback, and millions spent on technology upgrades...

• Predicting ICD-10 losses and tracking key performance indicators after October 1

  After several delays, ICD-10 implementation is finally upon us. The healthcare industry has spent...

• Providers need more time to analyze CMS' proposed bundled payment model

  Providers know the drill for addressing and operationalizing CMS' annual IPPS and OPPS updates...

Issue 10, October 1, 2015 - VIEW THE FULL ISSUE

• Prepare for ICD-10-CM implementation by reviewing common cardiac conditions

  Heart disease is the most common cause of death for both men and women in the U.S., according to...

• Reporting ICD-10-CM external causes is no joke

  When a patient suffers a traumatic injury or poisoning, we need to report how they became injured...

• Training tool: Common prefixes and suffixes quiz

  Use this 10-question quiz to determine how well you understand common medical prefixes and suffixes.

• E/M reporting remains a challenge in the ED

  Because CMS has not created any national ED E/M guidelines, providers must create their own...

Issue 9, September 1, 2015 - VIEW THE FULL ISSUE

• CMS proposes massive APC reconfiguration, updates 2-midnight rule

  The 2016 OPPS proposed rule released July 2 is deceptively short, but packs a punch. CMS is...

• CMS proposes 2% reduction in 2016 conversion factor due to laboratory overestimation

  OPPS costs rose approximately $1 billion more than expected in 2014 due to a CMS overestimation of...

• Comment on the 2016 OPPS proposed rule

  CMS wants your thoughts on the 2016 OPPS proposed rule changes. In various places in the proposed...

• Industry stakeholders respond to physician concerns with ICD-10 implementation

  Editor's note: This is the second in a two-part series on physician concerns about ICD-10. See the...

• Commenting to CMS on OPPS is more important than ever

  Editor's note: Jugna Shah, MPH, president and founder of Nimitt Consulting, writes a bimonthly...

Issue 8, August 1, 2015 - VIEW THE FULL ISSUE

• CMS adds code pairs for complexity adjustment in July quarterly I/OCE update

  CMS continues to update payment logic for comprehensive APCs (C-APC) with additional changes in the...

• A physician offers his perspective on ICD-10 implementation

  Physician groups have led much of the resistance against ICD-10 implementation. At its June...

• Coding Clinic defines ICD-10-CM seventh character

  We're less than four months away from the implementation of ICD-10-CM/PCS, and the AHA Coding...

• This Month's Coding Q&A

  Our experts answer questions about reporting ICD-10 strains and sprains,billing inpatient-only...

Issue 7, July 1, 2015 - VIEW THE FULL ISSUE

• Overhauled 2015 CPT drug test codes bring changes for coders and providers

  In an effort to accommodate the latest advances in technology and make the code set easier to...

• Use caution when applying modifier -59 for drug administration services

  Most coding professionals have heard modifier -59 (distinct procedural service) referred to as a...

• Providers continue to grapple with reporting modifier -25

  Lately I've received a lot of questions from hospitals about how to determine when and if it's...

• This Month’s Coding Q&A

  Our experts answer questions about drug panels ordered in the ED, edits for pain management codes...

Issue 6, June 1, 2015 - VIEW THE FULL ISSUE

• April I/OCE update continues to clarify comprehensive APC process

  The April quarterly I/OCE update from CMS did not defy convention?featuring the typically small...

• Recent rules and regulations should reduce provider ICD-10 uncertainty

  Providers have been plagued by uncertainty regarding ICD-10, with multiple delays pushing out...

• ICD-10 implementation requires ­organizationwide education and awareness

  Organizations must continue to educate and train staff throughout the transition to ICD-10 to...

• IPPS rule: Long outpatient stays with observation services to be discussed in 2016 OPPS rule

  The 2016 OPPS proposed rule is likely to continue CMS' trend of expanded packaging and feature...

• Refresh your knowledge of taxonomy codes

  Taxonomy codes play a very important role in medical billing and credentialing for providers or...

• This Month’s Coding Q&A

  Our experts answer questions about reporting myocardial infarctions in ICD-10-CM, documentation for...

Issue 5, May 1, 2015 - VIEW THE FULL ISSUE

• CMS releases update to correct and clarify comprehensive APC payments

  CMS released updated I/OCE specifications in January with several changes that could require...

• Start resolving ICD-10-CM questions

  Many coders rely on the AHA's Coding Clinic advice to resolve sticky situations with ICD-9-CM...

• Apply CMS' new -X{EPSU} modifiers

  When CMS introduced the -X{EPSU} modifiers in August 2014 to be used in specific instances to...

• HOP Panel discusses site parity, drug administration at latest meeting

  The policies that CMS publishes each year in the OPPS proposed rule don't always come as a...

• This Month's Coding Q&A

  Our experts answer questions about IV pushes, ICD-10-CM smoking details, and more.

Issue 4, April 1, 2015 - VIEW THE FULL ISSUE

• Medicine section updates reflect new products and technologies to report

  Each year, the AMA updates the Vaccines, Toxoids section of the Medicine chapter in the CPT®...

• Majority of industry stakeholders support ICD-10 implementation at House hearing

  When Congress delayed ICD-10 implementation in 2014 by inserting language into an unrelated...

• Reporting mental disorders in ICD-10-CM

  Mental health disorders are common in the United States, with an estimated 19% of Americans 18 or...

• This Month’s Coding Q&A

  Our experts answer questions about modifier -52 application, infusion coding, and more.

Issue 3, March 1, 2015 - VIEW THE FULL ISSUE

• CMS adds comprehensive APC logic in January quarterly I/OCE update

  The January quarterly I/OCE update includes new modifiers, changes related to expanded packaging...

• ICD-10-CM anatomy refresher: urinary system

  Editor's note: With the increased specificity required for ICD-10-CM coding, coders need a solid...

• Analyze the impact of comprehensive APCs

  The implementation of Comprehensive APCs (C-APCs) in the 2015 OPPS final rule likely wasn't a huge...

• This Month’s Coding Q&A

  Our experts answer questions about edits when reporting blood tests, updated vaccine codes, and...

Issue 2, February 1, 2015 - VIEW THE FULL ISSUE

• Musculoskeletal and nervous system sections get new procedure, combination codes

  As new and more effective treatment options are created and evaluated, AMA must update the...

• ICD-10-CM anatomy refresher: Reproductive system

  Since portions of the reproductive system use some of the same structures as the urinary system...

• CMS updates outpatient supervision level documents

  In December 2014, CMS posted a document on its Advisory Panel on Hospital Outpatient Payment (HOP...

• This Month's Coding Q&A

  Our experts answer questions about coding diabetes in ICD-10-CM, hypothermia coding for neonates...

• Salary survey results released

  Our sister website JustCoding.com recently published its 2014 Coder Salary Survey. Since many of...

Issue 1, January 1, 2015 - VIEW THE FULL ISSUE

• CMS finalizes comprehensive APCs with complexity adjustments for 2015

  In a concerted effort to move healthcare payments to a system of "quality over...

• CMS updates physician certification requirements for inpatient services

  CMS proposed that a new HCPCS modifier be appended to every code for a service furnished in a...

• Taking a three-dimensional look at CMS' finalized policies

  As CMS pushes the OPPS from a fee-for-service program toward more of a true prospective payment...

• This Month's Coding Q&A

  Our experts answer questions about outpatient queries and documentation for HCCs.