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APC Payment Insider reports on the latest coding and policy changes affecting Medicare outpatient billing under ambulatory payment classifications (APCs). This monthly newsletter offers proven strategies to succeed under CMS's outpatient prospective payment system (OPPS), plus ways to enhance chargemaster maintenance, recruit and retain qualified coders, speed billing turnaround, improve documentation habits, and use modifiers properly.

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APC Payment Insider

Issue 1, December 17, 2008

• ICD-10-CM

  Start planning now for transition from ICD-9-CM Q. I am responsible for the visit level and...

Issue 12, December 1, 2008 - VIEW THE FULL ISSUE

• Regulatory basis for self-administered drugs

  To understand self-administered drugs (SAD), begin by familiarizing yourself with key Medicare...

Issue 11, November 1, 2008 - VIEW THE FULL ISSUE

• Get ready now for ICD-10

  ICD-10 is no longer that monster over the horizon, under the bed, or in the closet. Years of...

• Eliminate unnecessary imaging services to meet planned APC payment reductions in the 2009 OPPS proposed rule

  In the September Briefings on APCs, an HCPro publication, Jugna Shah, MPH, president of Nimitt...

Issue 10, October 1, 2008 - VIEW THE FULL ISSUE

• Prefabricated splint codes: No easy answers

  When you ask any four coders or clinicians how to handle splint coding, you’re going to get...

• CMS proposes five new composite APCs, reduces drug reimbursement

  CMS released the display copy of the OPPS proposed rule for fiscal year 2009 on July 3, about three...

Issue 9, September 1, 2008 - VIEW THE FULL ISSUE

• Implement the new ESA transmittals in your hospital

  In her presentation during HCPro’s April 10 audio conference, Simmons described technical...

• Unraveling the costly inpatient-only procedures puzzle

  Few CMS rules are as confusing as those for inpatient-only procedures performed in outpatient...

Issue 8, August 1, 2008 - VIEW THE FULL ISSUE

• Implement the new ESA transmittals in your hospital

  Editor's note: This is the first article in a two-part series. In January, CMS published three...

Issue 7, July 1, 2008 - VIEW THE FULL ISSUE

• RAC report casts spotlight on wrong-setting errors

  Recovery audit contractors (RAC) have collected huge sums simply by comparing one-day stays with...

• Medically unlikely edits remain a puzzle to providers

  Earlier this year, CMS advised that the medically unlikely edit (MUE) value for units with CPT...

• Tune E/M documentation to meet the 2008 guidelines

  The 2008 OPPS final rule challenges outpatient facilities to be more exact than ever regarding...

• Infusions

  Editor's note: The following questions were answered by Cindy Basham, MHA, RN, CPC, CCS, senior...

Issue 6, June 1, 2008 - VIEW THE FULL ISSUE

• RAC report casts spotlight on wrong-patient settings

  Hospitals nationwide are taking notice of the Re-covery Audit Contractor (RAC) program and the 2007...

Issue 5, May 1, 2008 - VIEW THE FULL ISSUE

• Billing for packaged drugs: Meet coverage requirements

  If a drug is listed in OPPS Addendum B with a status indicator N (i.e., packaged), should a...

• Injections and infusions

  Use 96416 for prolonged infusion, 96522 for implantable pump or reservoir Q: Which documentation...

Issue 4, April 1, 2008 - VIEW THE FULL ISSUE

• Charge appropriately for radiopharmaceuticals in 2008

  Throw the notion out the window that your facility should not pay attention to the way it reports...

• Digest the new mandatory reporting requirements for ESA administration as of April 7

  In January, CMS published three transmittals that present sizeable operational challenges when...

Issue 3, March 1, 2008 - VIEW THE FULL ISSUE

• CMS publishes shocking FAQ about critical care information on its site

  CMS hosted its most recent hospital Open Door Forum call December 20, 2007, and it contained...

Issue 2, February 1, 2008 - VIEW THE FULL ISSUE

• Don't skip a beat during electrophysiology exams

  Editor's note: This article is the second in a two-part series. Part one was about...

• E/M expectations strike out again

  It's not a stretch to say that facilities' E/M hopes for 2008 were like that of a Little Leaguer...

Issue 1, January 1, 2008 - VIEW THE FULL ISSUE

• Pediatric, neonate critical care codes are not time based (per 30 minutes)

  Q: We are a facility that has a level II nursery (i.e., a unit that can attend to the needs of some...

• Go with the flow when coding EP exams

  Electrophysiology (EP) exams can resemble a sixth grader's Frankenstein science project: They...

• Observation coding and billing scenarios demystified

  Establishing definitions for what constitutes observation time has been the cause of much confusion...