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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, 2009 - VIEW THE FULL ISSUE

• Eliminate missed charges, errors to reduce lost revenue

  Operational inefficiencies, outdated technology, and silo thinking can all lead to lost revenue...

• Examine codes for complex OB/GYN procedures

  Understand how to sift through detailed OB/GYN operative notes to ensure accurate code assignment.

• Master modifiers to ensure accurate reimbursement

  Proper modifier use is a critical part of coding, billing, and reimbursement. Currently, coders can...

• ‘Clarification’ muddies the waters on lab order signatures

  If you thought you understood CMS’ policy when it comes to physician orders for clinical...

Issue 11, November 1, 2009 - VIEW THE FULL ISSUE

• Hospital outpatient departments need to know who is supervising

  The second part of our two-part series on supervision requirements for diagnostic services.

• Bill and charge for supplies correctly to reduce risk and lost revenue

  Make sure you are coding and billing supplies correctly to decrease revenue loss.

• I/OCE quarterly update: CMS addresses condition code 44, billing for radiopharmaceuticals and nuclear medicine

  Condition code 44, billing for radiopharmaceuticals highlight I/OCE changes

• Q&A: Determining the proper use of modifier -59

  Our experts answer questions about the appropriate use of modifier -59.

Issue 10, October 1, 2009 - VIEW THE FULL ISSUE

• Physician supervision requirements not limited to therapeutic services

  The first part of our two-part series on supervision requirements for diagnostic services.

• Two years later, MUEs are still a puzzle

  Given the continuing confusion, what can facilities do to handle MUEs?

• Modifier -59: Reduce risk, receive correct reimbursement

  Learn how to correctly use modifier -59 and when to avoid it.

• Coders beware?Is that screening colonoscopy really a screening?

  Coders must understand what constitutes a ‘screening’ colonoscopy.

• Coders beware?Is that screening colonoscopy really a screening?

  Coders must understand what constitutes a ‘screening’ colonoscopy.

Issue 9, September 1, 2009 - VIEW THE FULL ISSUE

• OPPS 2010 proposed rule: Earliest release brings fewer substantial policy changes

  The text portion of the 2010 OPPS proposed rule is shorter than previous years’ rules, and...

• 2010 OPPS proposed rule: CMS proposes more changes to physician supervision requirements

  Proposed changes to outpatient supervision could be a huge boon.

• Separately payable drugs: New calculation method proposed for 2010 doesn’t equal increased payment

  CMS proposes new methodology to calculate drug APC payment rates.

• Comment on the 2010 OPPS proposed rule

  Here’s how to submit comments to CMS.

• CMS discusses Section 1011 updates, OPPS proposed rule during HODF

  Several items of interest to OPPS hospitals from Open Door Forum call.

• Concepts review: Sort out packaged versus bundled services

  Q status indicators add to packaged vs. bundled confusion.

Issue 8, August 1, 2009

• Briefings on APCs, August 2009

  In this issue, you will find information about the new updates to the ICD-9 codes and look at how...

• New ICD-9-CM codes increase specificity

  ICD-9 code changes increase specificity to provide more information.

• Three new modifiers added for outpatient never events

  The I/OCE quarterly updates include new modifiers for never events.

• Ensure medical necessity to curb outpatient revenue loss

  Facilities are failing to meet medical necessity requirements

• Look to CMS, AHIMA for E/M leveling guidance

  Coders need an effective leveling system tool to choose the correct E/M level code.

Issue 7, July 1, 2009 - VIEW THE FULL ISSUE

• Inpatient ancillary services: Are your costs covered?

  As the current economic climate continues to constrict cash flow for consumers and payers alike...

• Set the bar with outpatient coding productivity standards

  Editor’s note: The results of the survey discussed in this article are based on responses...

• Carefully review CMS’ national coverage analysis on PET scans

  For years, it has been a challenge for healthcare facilities to determine whether Medicare will...

Issue 6, June 1, 2009 - VIEW THE FULL ISSUE

• Go electronic to improve compliant charge capture

  With increased ED volume and the demands of more complete documentation, now is the time to...

• Strong documentation puts OSA coverage trouble to sleep

  CMS’ decision to broaden coverage of sleep testing for OSA is good news for facilities if...

• CMS releases April I/OCE update

  CMS released its April 2009 quarterly update to the integrated outpatient code editor on March 13.

• Medicare: No coverage for virtual colonoscopy screening

  The virtual colonoscopy world may have to wait a little longer to get attention from Medicare.

Issue 5, May 1, 2009 - VIEW THE FULL ISSUE

• Solve the twin problems of ED revenue loss and compliance risk

  As always, E/M levels must reflect resources consumed, and you still must have written policies and...

• Review these important CY 2009 OPPS status indicator changes

  In 2008, CMS greatly expanded the number of packaged items and services payable under the OPPS...

• Conform to the new CMS physician supervision requirements

  Hospitals looking for more discussion about CMS? recent clarification of the direct supervision...

• Q&A: Assigning IV injection codes without stop times

  Q. Is it appropriate to assign an IV injection code when facility nursing documentation does not...

Issue 4, April 1, 2009 - VIEW THE FULL ISSUE

• Watch for changing physician supervision requirements

  Five successive pieces of CMS guidance in the past year have altered the landscape. They are...

• CMS reviews Negative Pressure Wound Therapy (NPWT) devices

  CMS has partnered with the Agency for Healthcare Research and Quality (AHRQ) to commission a review...

• Coders may not miss modifier -21

  The departure of modifier -21 (prolonged E/M services), effective with the 2009 CPT Manual, isn't...

• Understand when to append modifier -58

  It's often difficult for coders and providers to determine when it's appropriate to append modifier...

Issue 3, March 1, 2009 - VIEW THE FULL ISSUE

• ICD-10 effective October 1, 2013

  Start your transition now. The moment HIM departments nationwide have awaited for years has arrived.

• Control charge compression

  Charge compression is a complex, long-standing problem. And although CMS is only now recognizing...

• CMS Hospital Open Door Forum

  CMS discusses inpatient-only, direct supervision, ED encounters, and more CMS hosted a Hospital...

• CMS releases January I/OCE update

  CMS released its January quarterly update to the  I/OCE December 31, 2008, effective January 1...

• Clear up confusion regarding coding and billing for hospital supplies

  Coding and billing for hospital supplies can be confusing because of the complicated terminology...

Issue 2, February 1, 2009 - VIEW THE FULL ISSUE

• Charge compression basics

  Buried in the 2009 OPPS final rule’s 1,800-plus pages is a discussion of a fiscal phenomenon...

• CPT checkup: Review the major changes for 2009

  This is the second of two columns on the 2009 CPT changes that took effect January 1. It covers the...

• CPT: The back of the book and beyond

  Pay attention to new details in all three categories of CPT codes For many coders, the Category II...

• CMS corrects definitions of non-selective angiography codes in 2009 HCPCS update

  In 2003, CMS published revised definitions for two codes (G0275 and G0278), that describe...

• CMS opens the door to outpatient HAC program

  At a December 18, 2008 listening session, CMS presenters discussed possibilities for extending the...

Issue 1, January 1, 2009 - VIEW THE FULL ISSUE

• CMS releases 2009 OPPS final rule; trends continue

  New composite APCs, continued emphasis on efficiency, and revised definitions for new and...

• CMS issues annual HCPCS update for 2009

  The HCPCS Level II updates for 2009 appear to contain few startling items, but none that you should...

• New year brings more than 500 CPT changes

  Part one of a two-part series reviews changes to the 2009 CPT Manual for E/M, anesthesia, and...

• CMS Hospital Open Door Forum

  CMS hosted a Hospital & Hospital Quality Open Door Forum (HODF) conference call November 17...

• Revised CMS policy for bariatric surgery as a diabetes treatment

  CMS announced a proposal November 17 to clarify its policies about Medicare coverage of bariatric...

• Briefings on APCs 2008 index

  List of Briefings on APCs articles for 2008