tci ED Coding & Reimbursement Alert - 2000 Issue 6

Clarifying Critical Care Creates Reimbursement Opportunities

A December 1999 program memorandum from the Health Care Financing Administration (HCFA) makes life easier, if not better, for emergency departments. The good news is that the definition of critical care has been clarified for Medicare claims. The bad news is that HCFA believes the new regulations will result in more critical care billing, so reimbursement has been reduced. Critical care has changed, says Robert Kottman, MD, FACEP, president of Alamo Physicians Services Inc., an emergency physician billing service in Universal City, Texas. Medicare thinks the new guidelines will cause more billing and the time-related requirements could cause problems...

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