Medicare Compliance & Reimbursement - 2012 Issue 4
Facility Documentation Guidelines: Know the Rules for Mapping Professional and Facility Code Levels
Subscribe or sign in to view the full article.
Article Overview
This article covers CMS outpatient prospective payment system guidance related to emergency department facility-level documentation and mapping of professional versus facility code levels. It is aimed at hospital coders, compliance staff, revenue cycle teams, and documentation leaders who need to understand the general framework for creating, maintaining, and reviewing internal facility guidelines. The article discusses the source of CMS direction, the broad elements hospitals are expected to consider, and common categories of facility-level methodologies used in practice.
Why This Topic Matters
Hospitals must build and maintain defensible internal documentation guidelines when no national facility-level methodology is provided. Understanding the general CMS framework helps organizations support consistent coding, auditing, and compliance for emergency department facility services.
Article Sections
-
Basics
Introduces the distinction between professional and facility components in emergency department reimbursement and places the discussion in the context of CMS outpatient guidance.
-
Facility Guidelines Are Different From Those On The Professional Side
Describes the broad differences between hospital facility guidelines and professional service guidelines and explains the general resource-based framework referenced by CMS.
-
Make Sure You Also Document Medical Necessity
Addresses the role of clinically necessary documentation and the importance of avoiding policies that create unnecessary documentation burden.
-
Put Your Facility Guidelines In Writing!
Covers the need for written, consistent, auditable facility guidelines and their availability for review.
-
Consider These Options When Choosing A Mapping Methodology That Works Best For Your Hospital
Summarizes the broad types of facility guideline models used by hospitals and the general considerations involved in selecting and reviewing a methodology.
What You Will Learn
- How CMS outpatient guidance relates to emergency department facility-level documentation
- The general principles hospitals use when developing internal facility guidelines
- How facility-level methodologies differ from professional service coding approaches
- Why consistency, auditability, and medical necessity matter in facility documentation policies
- Common categories of hospital mapping methodologies used for facility coding
Who Should Read This
- Hospital coders
- Compliance officers
- Revenue cycle teams
- Emergency department documentation specialists
- Clinical documentation improvement staff
- Hospital auditors
Codes Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com