tci ED Coding & Reimbursement Alert - 2015 Issue 5

Facility Coding: Know These Rules for Emergency Department Facility Levels

Getting the facility payments right will help you keep your job there. CMS continues to have no official methodology for determining ED facility levels, but if you know where to look, there are some guidelines available for crafting your own. Read on to learn the source of CMS' guidance and tips on how to apply it to your practice. Basics: There are two components to consider when reviewing ED cases for reimbursement; the professional component for physician services and the facility component for other services which includes nursing and ancillary services. The CMS Outpatient Prospective Payment System (OPPS) gives...

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