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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 11, November 1, 2016 - VIEW THE FULL ISSUE

• Letter from the editor: Accessing your newsletter content

  The challenges healthcare professionals tackle each day don’t wait for solutions, and neither...

• Updated 2017 ICD-10-CM guidelines come 'with' controversial changes

  Just like the lyrics to the popular Gap Band song say, "You dropped a bomb on me… I...

• Making a checklist to prepare for the OPPS final rule

  The 2017 OPPS final rule will not be out for a couple of weeks, but that doesn't mean providers...

Issue 10, October 1, 2016 - VIEW THE FULL ISSUE

• CMS finalizes self-identified overpayments rule for services including Part B

  The Medicare Reporting and Returning of Self-Identified Overpayments final rule (81 Fed...

• Linking diagnoses and procedures to documentation in outpatient settings

    In the outpatient setting, we have a different set of rules to follow in regard to...

• Overcome billing and coding challenges for comprehensive observation services

  Billing correctly for observation hours is a challenge for many organizations. Getting it right...

Issue 9, September 1, 2016 - VIEW THE FULL ISSUE

• CMS looks to enact site-neutral payment policies for off-campus departments

   While the 2017 OPPS proposed rule includes a variety of tweaks and augmentations to existing...

• CMS proposes aligning packaging logic

   CMS proposes aligning its conditional packaging logic with how it applies packaging to labs...

• Forecasting financials based on CMS' latest proposals

   CMS’ proposed changes to implement Section 603 of the Bipartisan Budget Act of 2015...

• CMS proposes removing six codes from inpatient-only list, seeks TKA comments

   CMS released the 2017 OPPS proposed rule on July 5 without much fanfare. On July 14, the...

• Tips for sending CMS comments

   CMS wants your thoughts on its 2017 OPPS proposed changes. In various places in the proposed...

Issue 8, August 1, 2016 - VIEW THE FULL ISSUE

• CMS eases provider burden and reporting requirements in CLFS final rule

  CMS issued a final rule in June to revamp the way it pays for tests under the Clinical Laboratory...

• Billing therapy services in support of comprehensive APC services

  CMS' Transmittal 3523, issued May 13, is the quarterly July 1 OPPS update. In this transmittal, CMS...

• Challenges and opportunities in data analytics

  Healthcare organizations have become mass gatherers of data. But without sophisticated analytics...

• Reporting modifiers for services performed in the postoperative period

  Modifier -58 describes a staged or related procedure or service by the same provider during the...

Issue 7, July 1, 2016 - VIEW THE FULL ISSUE

• Survey respondents share their thoughts on HIM roles and compensation

  When compared to data from past surveys, HCPro's 2016 HIM director and manager salary survey...

• Determine the most appropriate laterality modifier

  Anatomical modifiers qualify a HCPCS/CPT® code by defining where on the body the service was...

• CMS issues new drug reporting requirement while providers wait on Part B payment model

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

Issue 6, June 1, 2016 - VIEW THE FULL ISSUE

• CMS adds laboratory drug testing codes, revises IMRT and SRS guidance

    The April 2016 I/OCE update brought a host of code and status indicator changes, as...

• Define outpatient CDI nuances

  As healthcare providers increasingly accept financial risk associated with patient management due...

• Training tool: CPT codes for shoulder surgery

  Use the quiz below to test your knowledge of CPT® codes for shoulder surgery.    

• Reporting CMS' modifiers related to Advance Beneficiary Notifications

  CMS' coding modifiers are not always used to report clinical components of a service. Sometimes...

Issue 5, May 1, 2016 - VIEW THE FULL ISSUE

• CMS proposes Part B drug payment test with flat-fee add-on, value-based purchasing tools

  CMS proposed an extensive five-year, two-phase plan to overhaul Part B drug payments for physicians...

• Impact of ICD-10 on physician workflow: The unforeseen consequences

  by Cyndi Pickney, DO, FACP

• CMS surprises with Part B drug payment model that puts the onus on providers

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

• The Provider Roundtable issues call for new members

  The Provider Roundtable (PRT) was established in 2003 to give CMS the benefit of providers' input...

Issue 4, April 1, 2016 - VIEW THE FULL ISSUE

• Post-implementation survey shows time spent coding increases for most ICD-10 record types

  In February 2016, just four months after ICD-10 go-live, sister publication HIM...

• Determine how Bipartisan Budget Act impacts off-campus departments, modifier -PO

  The new modifier -PO (services, procedures, and/or surgeries furnished at off-campus provider-based...

• Training tool: ICD-10-CM codes disorders of the skin and subcutaneous tissue

  Use the quiz below to test your knowledge of ICD-10-CM codes for disorders of the skin and...

Issue 3, March 1, 2016 - VIEW THE FULL ISSUE

• AMA updates genitourinary sections for new technology and terminology

  The 2016 CPT® code update may have been relatively small compared to previous years, but the...

• Pay attention to the hierarchy when reporting drug administration services

  The CPT Manual divides drug administration services into three different categories:

• Data accuracy is key for CMS to set payment rates, but guidance must be standardized

  This month's column is all about data--the importance of providers reporting accurate and complete...

Issue 2, February 1, 2016 - VIEW THE FULL ISSUE

• Digestive system has most changes for surgical procedures in relatively minor CPT update

  Perhaps recognizing the massive undertaking for coding and HIM departments in 2015 with the...

• Review proper procedures for applying modifier -52

  Per CPT1, modifier -52 is used when a service or procedure is partially reduced or eliminated at...

• AHA Coding Clinic for ICD-10 covers orthopedic and cardiovascular coding

  Some interesting tidbits of information can be gleaned from the most recent release of the AHA...

Issue 1, January 1, 2016 - VIEW THE FULL ISSUE

• CMS backs off some burdensome proposals but imposes negative payment update in latest rule

  The 2016 OPPS final rule includes the first negative payment update for the system, but CMS also...

• CMS shifts 2-midnight rule responsibility to QIOs, finalizes packaging expansion

  CMS finalized nearly all of its proposals related to packaging in the 2016 OPPS final rule. It...

• Accuracy is paramount for providers when reporting CMS' new modifiers for 2016

  Providers often struggle with modifiers?even those they've had available to report for many...

• This Month’s Coding Q&A

  Our coding experts answer questions about reporting twin births, tobacco use details in ICD-10-CM...