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- So How Do I Get Paid for This? APC, OPPS, IPPS, DRG? 08/21/2019
- Improving Risk Adjustment through Inpatient HCC Capture Rac Monitor
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Select the title to see a summary and a link to the full article. some articles require a subscription to view.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Hospitals are increasingly adopting innovative solutions to improve patient care and optimize processes and many of these solutions follow immediately the recent CPT and Medicare coding changes. In 2023 coding of hospital observation care services underwent significant changes enabling healthcare providers to accurately document and bill for the sick or injured patient that requires a higher level of medical services between the emergency room care and hospital admission. This article explores the key changes in coding hospital observation care services and their impact on healthcare delivery.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Healthcare is witnessing a digital revolution of sorts with advancements in technology that seem to transform many aspects of patient care. An example of this transformation involves the evolution of medical coding, where computer-assisted medical coding (CAC) and the use of artificial intelligence (AI) in medical coding are revolutionizing the way healthcare organizations document, process, and ensure medical necessity for healthcare services.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
If you have ever had a difficult time differentiating between the admitting diagnosis, principal diagnosis, and primary diagnosis then look no further. Each of these diagnoses play an important role in reporting services and ensuring correct coding and sequencing has occurred. Let's take a closer look at each of these diagnosis types and when they are reported.
Jan 10th, 2023
E/M Transformations and Clarifications Eff January, 1 2023
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Pay close attention to the new code description changes when coding E/M in 2023, the changes keep coming. Several codes have been consolidated, revised, or deleted. Learn what to look for in this article.
Jan 3rd, 2023
2023 Procedure Coding Updates Are Just Weeks Away
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Even with such a low number of code changes headed our way in 2023, the talk is all about Evaluation and Management (E/M) and speculation about whether our facilities will be able to meet the challenges associated with such a big change. In 2021, when the initial round of E/M changes were announced, they were backed up with a couple of years to prepare for implementation but for facility, it was just months.
by Ronald Hirsch, MD FACP CHCQM CHRI
Three items are discussed in this article: First, performing random audits of critical care visits billed with CPT codes 99291 and 99292 to ensure the patient was truly critically ill, which could help avoid recoupment. Secondly, time will tell if rural hospitals will switch to the rural emergency hospital designation. Lastly, a 2023 OPPS proposed rule, CMS discusses creating a new payment category, paying for software as a service.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
As the COVID-19-related public health emergency (PHE) seems to be dying down, CMS publishes the 2023 Medicare Proposed Rule that outlines more than a dozen major changes to existing programs, including some that relate to telemedicine after the PHE is declared officially over. Of the many changes, seven (7) really stand out and make us think about how the end of the PHE may affect services such as telemedicine or new E/M encounter types.
Jun 30th, 2022
More Audits and More Problems
by Ronald Hirsch, MD FACP CHCQM CHRI
More audits are coming, how do we stay compliant? We have been saying it but now it is happening. More audits are coming your way. One of the two CMS Recovery Audit Contractors seems to have taken on a business expansion plan. It appears they are contacting payers...
Jun 23rd, 2022
Why You Should Be Using The Two-Midnight Rule
by David M. Glaser, JD
Are you using something other than two-midnight? Here’s why you shouldn’t be. Is there the possibility that your utilization management team and physician advisors are applying InterQual, MCG, or any other utilization tool other than the two-midnight rule to your Medicare admissions? Over the last few months, it has...
by CMS - MLNConnects
News - Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023 - Men’s Health: Talk to Your Patients About Preventive Services - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes - ICD-10-CM Diagnosis Codes: Fiscal...
by Chelsea Richwine and Christian Johnson
New ONC data show that, as of 2021, nearly all non-federal acute care hospitals were enabled to electronically prescribe controlled substances (EPCS). According to the American Hospital Association (AHA) Information Technology (IT) Supplement Survey, the proportion of non-federal acute care hospitals enabled for EPCS increased from 67% in...
Jun 9th, 2022
The Nuances of the Two-Midnight Rule
by David M. Glaser, JD
When is a patient an inpatient? A reader we’ll call Michelle asked a question during a recent Monitor Mondays broadcast — a question that encapsulated many of them: how can a Medicare patient who stays two midnights for a non-medical reason be an inpatient? For example, consider a...
May 13th, 2022
The Conundrum Presented by Outpatient Surgeries
by Mary Beth Pace, RN BSN MBA ACM CMAC
Do you keep them under inpatient status? Or do you bring them in as outpatients and just keep them overnight? For our Medicare populations, in all of our organizations, the ability to follow the CPT code of the applicable surgical procedure is the determining factor to bill inpatient...
Apr 21st, 2022
2022-03-03-MLNC - 2022 Payment, Quality, & Policy Changes
by CMS - MLNConnects
News - Ambulance Prior Authorization Model Expands April 1 - Nutrition-related Health Conditions: Recommend Medicare Preventive Services - Claims, Pricers, & Codes - HCPCS Application Summaries & Coding Decisions: Drugs and Biologicals - Events - ICD-10 Coordination & Maintenance Committee Meeting — March...
by CMS - MLNConnects
News - COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELD - Program for Evaluating Payment Patterns Electronic Reports for Short-term Acute Care Hospitals - Quality Payment Program: 2020 Performance Information on Care Compare - Skilled Nursing Facilities: Submit Technical Expert Panel Nominations by March 16 ...
May 25th, 2021
PCS Coding for Ankle Fracture - Look Deeper Into the Codes!
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
If you're looking for ankle fractures in ICD-10-PCS, you may need to look a little deeper. Let's take a look at coding an ankle fracture such as a trimalleolar fracture. PCS coding can be confusing as it is nothing like CPT coding; with CPT we can simply code an ankle ...
Dec 8th, 2020
IPPS and DRG's: What it Means
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Understanding hospital pricing can get complicated, so we have broken it down according to CMS and the acute Inpatient Prospective Payment System, also known as IPPS. Find-A-Code uses IPPS for inpatient pricing with our MS-DRG grouper. The following information comes from CMS.gov and answers the most common questions regarding DRGs ...
Aug 5th, 2020
Coding with PCS When There is No Code
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn? To the guidelines, of course! There are ICD-10-PCS guidelines just as ...
Jul 1st, 2020
Understanding UCR Inpatient Fees used on DRGs
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Aug 21st, 2019
So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from? It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems. One of the ...
There are 17 related documentation, coding and billing tips.
Select the title to see a summary and a link to the full webinar information. some webinars require a subscription to view.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Emergency Department E/M services were significantly revised beginning in 2023. Key components as we knew them are gone and observation services were also changed. Join us for this informative webinar to learn what needs to be done to ensure that your documentation and coding practices are current and compliant.Jun 8th, 2023
Looking Closer at High Risk EM Medical Decision Making
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Thursday @ 10:15 AM PST, 11:15 AM MST, 12:15 PM CST, 1:15 PM EST Join us for a deep dive into the Evaluation & Management element of "Risk". Learn more about the differences between complications, morbidity, and mortality and how that drives coding. What does it really take for an encounter to be considered "High risk?"Mar 9th, 2023
Keeping up to date on reporting changes...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Properly reporting split or shared patient encounters can be tricky. The CPT codebook just began defining this type of encounter and the 2023 Medicare Physician Fee Schedule Final Rule included some changes. Tune into this informative webinar to ensure that you are doing things the right way.Jan 12th, 2023
Current Terminology - 2023 Annual Update Summary
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Be sure you are ready for 2023 with this review of the upcoming coding and reimbursement updates for 2023. This informative webinar discusses changes to CPT codes and guidelines including a summary of the changes to E/M services and an overview of changes to other CPT categories.by Find-A-Code™
Do your providers perform and report Evaluation and Management (E/M) services in the inpatient setting? Does the documentation match with the services being billed, or does it fall short? Join Aimee for a hands-on audit of an inpatient E/M service and get an idea of the information and documentation needed to correctly code inpatient E/M services.Links and resources by topic.
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