ED Coding & Reimbursement Alert - 2012 Issue 3
Industry Notes: $6 Million Question for Denver Hospital -- 'Observation,' 'Inpatient,' Or 'Outpatient'?
Subscribe or sign in to view the full article.
Article Overview
This industry note reviews several current Medicare and audit-related coding issues for hospitals, physicians, and home health providers. It highlights a settlement involving inpatient versus outpatient/observation status, then outlines Recovery Audit Contractor focus areas, including evaluation and management billing, surgery and add-on code reviews, global period claims, chemotherapy administration, and documentation concerns. It also summarizes Medicare contractor guidance on home health face-to-face encounter documentation and billing timing. The article is useful for coders, compliance staff, auditors, and revenue cycle teams monitoring payer review activity and Medicare billing requirements.
Why This Topic Matters
The topics discussed can affect claim payment, audit exposure, and compliance risk across multiple care settings. Understanding the broad areas under review helps organizations monitor billing practices and documentation processes that are likely to draw payer scrutiny.
Article Sections
-
Hospital admission status and settlement context
Discusses a hospital settlement tied to admission status concerns and the broader compliance issue of distinguishing among care settings. The section frames why inpatient, observation, and outpatient classification matters to billing and audit risk.
-
Check Out What Your RACs Are Reviewing These Days
Summarizes several Recovery Audit Contractor review topics affecting physician, facility, and outpatient claims. The section covers audit focus areas across multiple regions and types of services.
-
Don't Waste Your Time With An Extra Home Health Face-To-Face Visit When You Don't Have To
Reviews Medicare contractor guidance on home health face-to-face encounter documentation and billing timing. The section addresses provider questions about whether documentation can be reused and when billing is permissible.
What You Will Learn
- How current audit activity is affecting hospital, physician, outpatient, and home health billing
- What broad categories of claims are being reviewed by Recovery Audit Contractors
- What Medicare contractor guidance says about home health face-to-face encounter documentation
- Why patient status classification remains a compliance-sensitive issue
Who Should Read This
- Medical coders
- Compliance officers
- Revenue cycle staff
- Billing managers
- Hospital auditors
- Home health administrators
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com