There is an extensive list of coverage requirements that must be met to furnish outpatient services to Medicare beneficiaries. Gina M. Reese, RN, JD, CPHRM , discusses some of the trickier issues that facilities will need to audit more carefully while monitoring for compliance in provider-based departments.
While you thought that we’ve finally mastered coding compliance with DRGs and quality measures, now it is time to learn the compliance risks and opportunities with a new risk-adjustment method applicable to MACRA, Hierarchical Condition Categories (HCC).
Most healthcare systems already have a proven process in place to monitor revenue integrity and ensure correct reimbursement. Beyond the day-to-day revenue cycle staff involved in revenue integrity, more than 60% of hospital executives believe revenue integrity is essential to their organization’s financial stability and sustainability, according to a survey by Craneware, Inc .
A recent Coding Clinic has garnered a lot of questions on inpatient obstetrics coding. While coders were originally taught to use multiple codes for the repair of a third- or fourth-degree perineal laceration, Coding Clinic , First Quarter 2016, states that you don’t use multiple codes for third- and fourth-degree tears, because you need to code to the “deepest layer.”
Turning the microscope to critically examine the program you painstakingly created is no easy task. It is a challenging process that requires a fair amount of humility and humbleness. It’s hard to accept that your program, your staff, and you (the physician advisor) might suddenly not be as effective as you previously believed. Believe me, I speak from experience.
CMS issued SE1609 to clarify long-standing policy concerning external infusion pumps. Apparently, both freestanding physician offices and outpatient hospital departments were treating external pumps as an item of durable medical equipment, even when the physician or hospital department set up the pump on the patient, supplied the drug, and programmed the infusion rate and dose into the pump.
There is an extensive list of coverage requirements that must be met to furnish outpatient services to Medicare beneficiaries. Hospitals may find that certain coverage requirements for therapeutic and diagnostic service are more difficult to meet than others, especially in off-campus provider-based departments.
When CMS introduced Hierarchical Condition Categories with risk-adjusted scores, Ochsner Health System began efforts to educate providers and improve documentation across its many facilities.
Traditionally, the OPPS rulemaking cycle has been the main vehicle for changes to outpatient coding and billing regulations and policy that hospitals need to pay attention to. But Jugna Shah, MPH , writes that, increasingly, CMS has been introducing or discussing changes relevant to outpatient hospitals beyond the scope of the OPPS rules.
