Q&A: You've got questions! We've got answers!
Physician Practice Insider, May 26, 2017
Submit your questions to Editor Karen Long Rayburn at klong@decisionhealth.com, and we will work with our experts to provide you with the information you need.
Q: Did something change with the observation services Composite APC in 2016? The director of patient financial services says we no longer receive payment for it.
A: The observation services Composite APC (APC 8009) was replaced with a single comprehensive APC (C-APC 8011) for CY 2016. Along with the new C-APC comes new status indicator J2. Services assigned to J2 are considered to be adjunctive services and components of C-APC 8011, and this will result in a single payment for these services reported as part of the comprehensive observation services APC. The J2 designation and the payment are based at the claims level and not per date of service.
The good news is that the requirements to meet the observation services C-APC are the same as for the Composite APC (e.g., clinic/ED visit, eight or more units of G0378, etc.). Even more good news is that the ED visit level requirement now includes all Type A and Type B ED levels and critical care; the level is no longer limited to the higher ED visit levels.
Be sure that all services provided continue to be reported to insure that all costs pertaining to the individual patient’s scenario are included in your claims data. CMS will continue to expect and rely on the claims data for rate setting under the OPPS.
For more information, see the Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.3, 10.4, 290.5.1. 290.5.2 and new section 290.5.3.
Editor’s note: This question was answered by Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions in Fort Lauderdale, Florida. This information does not constitute legal advice. Opinions expressed are that of the author and do not represent DecisionHealth, HCPro, or ACDIS. Email your questions to Editor Karen Long Rayburn at klong@decisionhealth.com.
Related Products
-
Physician Practice Perspective
Physician Practice Perspective subscribers can find the archive of issues on the Part B News website. Find more information...
-
Medical Environment Update
A subscription to Medical Environment Update pays for itself by saving you time sorting through complex regulations and...
-
HealthLeaders Media Physician Leaders
HealthLeaders Media Physician Leaders offers commentaries that focus on the hottest issues for doctors as well as concise...
-
Medical Environment Update - Electronic and Print, 1 year
A subscription to Medical Environment Update pays for itself by saving you time sorting through complex regulations and...
-
Medical Environment Update - Electronic, 1 year
A subscription to Medical Environment Update pays for itself by saving you time sorting through complex regulations and...
Most Popular
- Articles
-
- Don't forget the three checks in medication administration
- ICD-10-CM coma, stroke codes require more specific documentation
- Complications from immobility by body system
- Practice the six rights of medication administration
- Note similarities and differences between HCPCS, CPT® codes
- OB services: Coding inside and outside of the package
- Q&A: Primary, principal, and secondary diagnoses
- Neurological checks for head injuries
- Understanding and coding for critical care services
- Pneumonia with a negative chest x-ray: Clinical diagnoses, physician documentation, and coding guidelines
- E-mailed
-
- Using the JCAHO's six competencies to evaluate MD performance
- Q&A: Why can’t we bill ventilator management in the ED?
- Q&A: Measuring CDI specialist productivity
- Pneumonia with a negative chest x-ray: Clinical diagnoses, physician documentation, and coding guidelines
- Consider these strategies to bill non-qualifying inpatient
- Searched
