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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, 2008 - VIEW THE FULL ISSUE

• Make determinations for self-administered drugs

  In this second article in a two-part series, William L. Malm, ND, RN joins Andrew Ruskin, Esq. to...

• Advisory panel against decreasing separately payable drug reimbursement for 2009

  One of the more controversial provisions of the 2009 OPPS proposed rule is CMS’ plan to...

• Medicare publishes Medically Unlikely Edits

  CMS announced October 1 that it would immediately publish most of the edits used in its Medically...

• October Open Door Forum

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

• ICD-10 implementation timetable draws fire and support

  The debate over implementation of ICD-10 sharpened as the comment period ended in October and...

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

• Make determinations for self-administered drugs

  This is the first article in a two-part series. It provides the legal background of...

• Decipher integumentary codes for correct coding

  Differentiate transfers, flaps, and grafting procedures, and make use of new codes and any trick to...

• Proposed payment changes to Type B EDs

  CMS has proposed to create four new APCs for Type B ED visits in the 2009 OPPS proposed rule, based...

Issue 10, October 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...

• Meet planned APC payment reductions: eliminate unnecessary imaging services

  Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, C-CDIS says without changing the way that...

• Questions on E/M for hospital-based outpatient clinics

  Editor’s note: Susan Garrison, CHCA, PCS, FCS, CPC, CPC-H, CCS-P, CHC, CPAR, executive vice...

• Decipher integumentary codes for correct coding

  Be aware of all your options when coding integumentary procedures so that you arrive at the most...

• Reminder: Medicare covers diabetes screening

  On June 18, CMS issued MLN Matters article SE0821, a reminder that Medicare pays for diabetes...

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

• 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, some three...

• Avoid encoder traps

  Encoders are among the most valuable coding resources on the market, but software is just one tool...

• Prefabricated splint codes: No easy answers

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

• CMS discusses MIPPA, incident-to services, and more

  CMS hosted its most recent Hospital Open Door Forum (ODF) call July 17, during which it addressed...

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

• Implement the new ESA transmittals in your hospital

  Editor's note: In the July Briefings on APCs, part one of this two-part series featured Jennifer...

• Unraveling the costly inpatient-only procedures puzzle

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

• CMS Hospital Open Door Forum update

  CMS hosted its most recent Hospital Open Door Forum (ODF) call June 12, during which it addressed...

• CMS releases July I/OCE update

  CMS released its July quarterly update to the I/OCE on May 30, effective July 7 ("July 2008...

• Outpatient coders not exempt from the FY 2009 ICD-9 code changes

  The National Center for Health Statistics (NCHS) released its annual ICD-9-CM code changes May 30...

Issue 7, July 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...

• Documentation improvement: Take a team approach

  Editor's note: In the June Briefings on APCs, "Tune your E/M documentation to meet guidelines...

• Keep up to date on these important CMS transmittals

  Editor's note: A summary of the April CMS I/OCE update-Transmittal 1483-appeared in the June...

• Report modifier -JW for discarded amounts of single-use drugs and biologicals: CAP participants excluded

  Providers should report modifier -JW ("Drug or biological amount discarded/not administered to any...

• Q&A: Experts tackle billing for implantable devices

  Editor's note: Kimberly Anderwood Hoy, Esq., JD, CPC, director of Medicare and compliance at HCPro...

• Coder vs. biller: Does this match have a referee?

  The subject can come up at any gathering of HIM professionals: the friction that can arise between...

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

• Medically unlikely edits remain a puzzle to providers

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

• RAC report casts spotlight on wrong-setting errors

  Editor's note: The first article in this two-part series appeared in the May BAPCs. It discussed...

• Tune E/M documentation to meet the 2008 guidelines

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

• Scheduled versus unscheduled ED care still confusing

  Questions from the March 18 HCPro audioconference, "Facility E/M Update: Meet CMS' Latest Coding...

• OPPS packaging: Addressing CMS' expansion and assessing the financial effect on your facility

  With the release of the 2008 OPPS final rule, CMS took drastic steps toward more aggressive...

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

• RAC report casts spotlight on wrong patient settings

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

• New information for ED trauma coding and charge capture creates confusion

  New CMS guidance regarding services included in critical care CPT codes-codes that were commonly...

• Wound care coding and billing: Address compliance risks

  Lingering coding and billing difficulties, 2008 CPT/HCPCS changes, and OIG scrutiny promise to keep...

• CMS releases an improved Advance Beneficiary Notice

  In a much anticipated move, CMS released its new Advance Beneficiary Notice (ABN) of Noncoverage...

• CMS discusses new Medically Unlikely Edits, inpatient versus observation status during recent ODF call

  CMS hosted its most recent hospital Open Door Forum (ODF) call March 13 in which it addressed...

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

• Drug administration challenges continue

  Despite the fact that the 2008 OPPS final rule did not make any major drug administration changes...

• 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...

• CMS discusses NPI, ESA billing, critical care, and more

  CMS hosted its most recent hospital Open Door Forum (ODF) call January 31, in which it addressed...

• Drug administration Q&A: Answers to difficult questions

  Editor's note: Jugna Shah, MPH, president of Nimitt Consulting in Washington, DC, and Valerie...

• ED revenue cycle management

  Editor's note: The following article is an excerpt from a white paper by Malm on ED revenue cycle...

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

• Check out observation criteria changes

  In the 2008 OPPS proposed rule, CMS had anticipated eliminating separately payable observation APC...

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

• CMS publishes shocking critical care information

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

• Take a closer look at expanded packaging for 2008

  One of the most significant changes to the OPPS since its August 2000 inception occurred in...

• 2008 OPPS final rule a 'radical change,' sources say

  Editor's note: This article is the second in a two-part series. Part one examined 2008 changes to...

• Q&A: 2008 OPPS final rule

  Editor's note: Valerie A. Rinkle, MPA, revenue cycle director for Asante Health System in Medford...

• Q&A: Experts set the record straight on modifiers -58, -59

  Editor's note: Modifier -59 CPT language was modified for 2008. The term "physician" was removed...

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

• 2008 OPPS final rule a radical change, sources say

  Editor's note: This article is the first in a two-part series. Part one covers packaging...

• Don't skip a beat during electrophysiology exams

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

• CMS discusses 2008 OPPS final rule and more

  CMS hosted an Open Door Forum conference call for hospitals on November 8, 2007. The following...

• 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...