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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, 2004 - VIEW THE FULL ISSUE

• OPPS final rule brings big changes

  The 2005 OPPS final rule brings several significant changes for providers, including new codes for...

• Best practices: Solutions for maximizing efficiency under APCs

  Following a claim through a process that includes physician documentation, coding, billing, and...

• New 'Welcome to Medicare' exam easy as one, two, three, four codes

  The OPPS final rule includes an allowance for an initial preventive exam for all new Medicare...

• Providers: How you report data in 2005 will determine how you are paid in 2007

  Over the years, I've stressed the importance of reporting complete and accurate claims data...

Issue 11, November 1, 2004 - VIEW THE FULL ISSUE

• The software solution: Improve your compliance, reimbursement

  Catholic Healthcare West (CHW) in San Francisco has 40 hospitals in three states, with monthly...

• Chargemaster maintenance a key component of revenue cycle

  It's a lesser-known but startling fact: Approximately 70% of all coding errors under OPPS result...

• Use modifiers -59, -91 to explain duplicate codes

  Modifiers -59 and -91 can help hospitals reduce denials from Medicare fiscal intermediaries (FI...

• Navigate injection and infusion therapy using these experts' advice

  Due to a lack of national guidance, coding and charging chemotherapy administration and...

Issue 10, October 1, 2004 - VIEW THE FULL ISSUE

• National E/M guidelines remain three to four years away

  In the 2005 OPPS proposed rule issued August 16, CMS indicated that new national facility E/M codes...

• Get a head start: Audit for impacts of the 2005 OPPS proposed rule

  Part two of a two-part series. Part one ran in the September BAPCs. If the 2005 OPPS proposed rule...

• Make sure your facility accurately codes for E/M visits

  Coding for the E/M of planned procedures often confuses hospitals and clinics. They're unsure...

• Panel of peers readies comments on 2005 OPPS proposed rule

  Like managing OPPS and APCs, some things get easier with experience. At least, that's what members...

• Prepare your facility for changes to inpatient-only list

  Twenty-two HCPCS codes could be removed from the inpatient-only list and covered under OPPS if the...

Issue 9, September 1, 2004 - VIEW THE FULL ISSUE

• OPPS proposed rule alters outliers, observation, drug administration

  CMS published the proposed 2005 OPPS rule, and the big news is that there's no news concerning...

• Audit for financial impacts of the 2005 OPPS proposed rule

  Part one of a two-part series Should the 2005 OPPS proposed rule become final, APCs will see...

• Send comments and questions to CMS on the OPPS proposed rule

  Now is the time to comment on the 2005 OPPS proposed rule. Policy changes are subject to a 60-day...

• Thank you notes are in order to CMS

  "OPPS Advisor" is written by Jugna Shah, MPH, president of Nimitt Consulting, Inc., in St. Paul...

Issue 8, August 1, 2004 - VIEW THE FULL ISSUE

• Losing dollars in translation? Consider a dedicated ED coder

  The ED continues to drain substantial reimbursement from many hospitals. From the time a physician...

• Increase wound care coding efficiency using practical methods

  To receive APC payment and meet compliance regulations, facilities must follow specific...

• Correct coding is in the eyes of the beholder

  Coding eye procedures can be tricky, frustrating, and time-consuming. The charts of eye procedure...

• Q&A: Solutions to OPPS challenges

  Experts Gloryanne Bryant, BS, RHIT, CCS, director of coding/HIM compliance for Catholic Healthcare...

Issue 7, July 1, 2004 - VIEW THE FULL ISSUE

• Audit records for 12 areas that may be draining dollars

  Gloryanne Bryant BS, RHIT, CCS, dubs them the "mighty dozen." They're 12 commonplace procedures in...

• Half of coders say APCs haven't made coding job better or worse

  Almost half of coders (48%) surveyed said that since the advent of OPPS and APCs, the coding...

• Teach staff guidelines for delivering ABNs

  Although the patient's physician is the best individual to prepare an ABN, most physicians do not...

• Modifiers -CB, -KD, and -KF in effect now

  In releasing the changes to OPPS effective July 1, 2004, CMS included only one modifier...

Issue 6, June 1, 2004 - VIEW THE FULL ISSUE

• Develop an E/M level service matrix to capture facility-based ED revenue

  A documentation matrix for ED services can help your facility stay compliant and capture all...

• Appeal ED diagnosis testing denials

  If you receive denials for reasonable and necessary tests performed in your ED, faulty coding and...

• Review your LMRP before coding 'gutcam'

  BAPCs and its sister publication, APC Answer Letter, have received several inquiries about coding...

• Real-life coding: Ultrasound-guided paracentesis and fluid aspiration

  Editor's note: BAPCs and Lolita M. Jones, RHIA, CCS, of Lolita M. Jones Consulting in Fort...

• Form steering committee for smooth transition to ICD-10

  The ICD-10-CM coding system could take effect as soon as 2007. When the data is announced in the...

Issue 5, May 1, 2004 - VIEW THE FULL ISSUE

• Tips for improving physician documentation

  The adage that you catch more flies with honey is right on the money when you're talking about...

• Left, right, or -50: Choose the correct modifier for bilateral coding

  Facility audits and payer reviews show that bilateral modifiers are still coded inaccurately...

• Report: Payers don't adhere to code-set guidelines

  A correct coding initiative group in Massachusetts researched how payers reimburse for bilateral...

Issue 4, April 1, 2004 - VIEW THE FULL ISSUE

• CMS issues codes for brand-name drugs, but no method of charge

  Your facility could be losing money when billing drugs with no way to receive the difference in...

• Try these strategies to get reimbursed for off-label drug use

  Food and Drug Administration (FDA) approval of off-label drug use often is required for Medicare...

• Not auditing modifier use can lead to OIG trouble

  If your facility is not monitoring how it uses modifiers, it is putting itself at risk for an OIG...

• APC Advisory Panel discusses observation, E/M facility levels, chemo coding

  Editor's note: Jugna Shah, MPH, president of Nimitt Consulting, Inc., in St. Paul, MN, writes "OPPS...

Issue 3, March 12, 2004 - VIEW THE FULL ISSUE

• Once burned, CMS and OIG try to avoid fraud with better definitions

  In September 2003, the Office of Inspector General (OIG) published in the Federal Register its...

• What you need to know about MMA's impact on OPPS

  Ramifications of the Prescription Drug Improvement Act of 2003 (MMA) are still coming to light...

• Coding cancer therapy administration begins with location of injection

  To correctly code anticancer drug injections, you must first determine the location of the...

• Real-life coding: Don't miss injection pays use modifier -59 with infusion thera

  Editor's note: BAPCs and Lolita M. Jones, RHIA, CCS, of Lolita M. Jones Consulting in Fort...

Issue 2, February 1, 2004 - VIEW THE FULL ISSUE

• CMS technicality doesn't allow for observation after midnight

  At Lakes Regional Healthcare in Spirit Lake, IA, a patient presented to the ED at 10:30 p.m...

• Coder-driven capture of charge data takes work but provides results

  The coding administration at Kent Hospital in Warwick, RI, asked its coders to do more work for the...

• Two Federal Registers create numerous changes in the 2004 OPPS final rule

  "OPPS Advisor" is written by Jugna Shah, MPH, President of Nimitt Consulting, Inc., in St. Paul...

• Survey reveals variation in evaluation and management service coding hospital ED

  A study performed by the American Hospital Directory (AHD) reveals that some hospitals are still...

Issue 1, January 1, 2004 - VIEW THE FULL ISSUE

• OIG 2004 Work Plan targets several outpatient hot spots

  The 2004 Work Plan issued by the Office of Inspector General (OIG) has fewer coding and billing...

• What do the OPPS changes mean for your facility?

  If you don't enjoy doing puzzles, you probably won't like performing an impact analysis for your...

• Medicare prescription drug bill increases paymentsto OPPS providers-at least unt

  The Medicare Prescription Drug and Modernization Act of 2003 will mean more money for OPPS...