Revenue Cycle Newsletters

Briefings on APCs Briefings on Coding Compliance Strategies HIM Briefings Managed Care Contracting and Reimbursement Advisor Strategies for Health Care Compliance

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.

Subscribe »

2016 | 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2002 | 2001

Issue 11, November 1, 2005 - VIEW THE FULL ISSUE

• Drug admin codes don’t paint a pretty picture for OPPS hospitals

  AMA preview of new CPT codes reveals billing concerns The American Medical Association (AMA...

• Expect patient backlash from Part D problems in your facility

  Hospitals must bill self-administered drugs to outpatients Hospital outpatient departments may...

• Build strong IR coding foundation before tackling claims

  Many providers believe that interventional radiology (IR) diagnostic coding is complicated, "and it...

• Service modifiers negate need for C codes with device-dependent procedures

  In this month's "Modifier Clinic," Lolita Jones, RHIA, CCS, of Lolita M. Jones Consulting in Fort...

• Keep your facility abreast of changes in October OCE

  CMS released in October its quarterly update to the OCE in Transmittal 683 ("October 2005 OPPS OCE...

Issue 8, August 1, 2005 - VIEW THE FULL ISSUE

• 2006 proposed OPPS rule brings changes and challenges for providers

  CMS’ early release of the 2006 proposed OPPS rule on July 18 left me feeling positive, but a...

• Got denials? Take a team-oriented approach to clean claims

  The number of claims denials in the gastrointestinal (GI) department at Roper St. Francis...

• Start your facility off using smoking cessation G codes

  In its latest quarterly OPPS update, CMS issued two new G codes that allow hospitals to bill for...

• Find light at the end of the CVA coding 'tunnel’

  Proper documentation critical when assigning 36560-36561 Documentation stating the use of...

Issue 7, July 1, 2005 - VIEW THE FULL ISSUE

• Will your facility be paid for packaged services in 2006?

  If members of the Provider Roundtable (PRT) have anything to say about it, 2006 could be the year...

• Drug administration coding, billing often in the eye of the FI

  A patient is transported via ambulance to your hospital’s ED. En route to your facility...

• Keep an eye on medical necessity when ordering PET-CT scans

  Facilities that bill the new PET-CT-positron emission tomography, or PET, with concurrently...

• Don’t report modifier -59 with 76000 and a bronchoscopy code

  Final article in a three-part series This year, in its annual Work Plan, the OIG set its sights...

Issue 12, December 1, 2005 - VIEW THE FULL ISSUE

• 2006 OPPS final rule delivers newdrug administration rules and more

  Mix of good/bad news for providers The release of the 2006 OPPS final rule November 2 proved...

• Use these six tips to appeal non-Medicare denials in your facility

  Appealing denied claims is the specialty of Terri Rinker, MHA, reimbursement manager for Community...

• Use SWOT to attack top 10 changes in OPPS final rule

  By Andrea Clark, RHIA, CCS, CPC-H To deal with the big changes in the 2006 OPPS final rule and...

• New transmittal fixes repetitive services billing

  Radiation therapy dropped from list of separately billed services Hospitals must separate...

Issue 10, October 1, 2005 - VIEW THE FULL ISSUE

• Proposed drug handling C codes a heavy burden for hospitals

  Some of the biggest changes in the 2006 OPPS proposed rule concern the reporting and payment of...

• A clear look at the three-day window

  Because many hospitals don’t understand Medicare’s three-day payment window regulation...

• Provider Roundtable weighs in on OPPS proposed rule

  Want to know what your colleagues from around the country think of the 2006 OPPS proposed rule...

Issue 9, September 1, 2005 - VIEW THE FULL ISSUE

• Prepare your facility for the proposed OPPS drug administration changes

  Review definitions, documentation, and necessity guidelines Although the new drug...

• Observation: Simpler rules make it easier for providers to get paid

  Many providers believe that trying to qualify for the separately payable observation APC 0339, as...

• Other proposed changes that may affect your hospital

  Other notable changes in the 2006 OPPS proposed rule, in addition to the simplification of the...

• To code/not to code ED fracture care: A difficult question

  To code or not to code fracture care in the ED: It’s a question asked by HIM personnel and...

• Use modifiers -76, -77 to indicate repeat procedure

  Use modifier -76 (repeat procedure by same physician) or -77 (repeat procedure by another...

Issue 6, June 1, 2005 - VIEW THE FULL ISSUE

• The wait is over for billing blood and blood products

  Long-awaited CMS transmittal answers, raises questions It’s been five years in the...

• OPPS drug administration clarified

  CMS transmittal 566 updates hospital coding and billing By Jugna Shah, MPH Since its...

• Are these missing codes costing your facility money?

  HIM departments across the country are failing to report a long list of HCPCS procedure codes, and...

Issue 5, May 1, 2005 - VIEW THE FULL ISSUE

• Sharpen physician documentation with these simple strategies

  This is part two of a two-part series. Part one covered nursing documentation. Facility coders...

• Nine tips to prevent incorrect inpatient admissions

  A patient reports to your hospital on a Saturday afternoon with lightheadedness and nausea. You...

• Bypass NCCI edits with modifier -59, as appropriate

  Editor's note: This is part one of a three-part series. In 2005, the OIG stated that it will...

• Coding for critical care: It's in the timing

  Critical care in the ED is billed using time as a component, but the rules differ slightly for...

• Don't overlook observation nursing services

  Tips for coding, charging bedside procedures Hospitals often fail to code or capture the...

Issue 4, April 1, 2005 - VIEW THE FULL ISSUE

• Correct documentation: Coding and reimbursement depend on it

  Documentation is the bedrock for proper claims submission and payment. Before HIM can assign the...

• Follow new code changes to receive proper payment for CVA procedures

  During 2001 and 2003, insertion of a central venous access (CVA) device-regardless of central v...

• APC Advisory Panel provides a glimpse of 2006

  The APC Advisory Panel met in Baltimore on February 23-24, 2005. This meeting of the panel was...

Issue 3, March 1, 2005 - VIEW THE FULL ISSUE

• Tackle seven OIG risk areas with these compliance tips

  How accurately does your facility code outpatient claims? Do you submit proper procedure codes and...

• Modifier clinic: New reporting guidelines for -52, -73, and -74

  On January 21, CMS released a major update that both clarifies and changes the reporting of...

• Five scenarios to improve drug administration coding

  It's pretty clear by now that you must report CPT codes instead of Q codes to Medicare for drug...

Issue 2, February 1, 2005 - VIEW THE FULL ISSUE

• Change in repetitive services billing increases workload

  Medicare will no longer allow you to include both repetitive and nonrepetitive OPPS services on the...

• The device C code requirement may be a blessing in disguise

  For services provided on or after January 1, you must include a select number of device category C...

• Take a closer look at observation, other OPPS changes

  CMS significantly simplified observation in 2005, making it easier for providers to meet and get...

• Drug administration '05: CMS creates clarity-and more questions

  Given the recent CMS change from Q to CPT codes, it's more critical than ever that your...

Issue 1, January 1, 2005 - VIEW THE FULL ISSUE

• Modifiers targeted in the crosshairs of the 2005 OIG Work Plan

  The 2005 OIG Work Plan targets several outpatient services (e.g., E/M levels, wound care), with...

• Get your facility ready for financial changes with 2005 OPPS rule

  The 2005 OPPS final rule includes approximately 82 new APCs, a host of new and discontinued codes...

• Modifier reporting more important than ever in 2005

  The 2005 OPPS final rule contains substantial changes for providers, most notably in the areas of...

• Providers: Prepare for January OCE update

  In December, CMS released its latest update of OCE, version 6.0. The new version has a few small...