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Hospital Articles and Resources

Hospital Billing tools offer many solutions to support hospital billing processes as well as auditing, payers' pricing, life planning and more....

Use the DRG Grouper to determine how much Medicare will pay, further group DRG's into Major Diagnostic Categories (MDCs), and use the ICD-10-PCS official guidelines to ensure compliance.

 

Code Sets

DRG Codes

Diagnosis Related Group (DRG) Codes

ICD-10-PCS Procedure Codes

ICD-10-PCS Procedure Codes Search

Find-A-Code's Tools & Resources

MS-DRG Grouper

Quickly find a DRG based on ICD-10-CM Diagnosis codes and ICD-10-PCS Procedure Codes

DRG Grouper Tutorial

DRG Grouper Tutorial

Facility NCCI Edits Validator

Validate using NCCI edits for errors in code selection.

Additional Links and Resources

Guidelines & Manuals

Search Links and Resources by Category

ICD-10-PCS Guidelines

Official ICD-10-CM Guidelines for Coding and Reporting

Claim Form Instructions

Instructions for the UB04/CMS1450 02/12 Claim Form

PUB 100 - Medicare IOMs

PUB 100 - Medicare Internet-Only Manuals (IOMs)

Medicare Claim Review

Medicare Claim Review Programs

MLN Booklet: Medicare Billing

Medicare Billing: Form CMS-1450 and the 837 Institutional

Newsletters

Newsletters and Articles

2020 ICD-10 PCS Codes

These 2020 ICD-10-PCS codes are to be used for discharges occurring from October 1, 2019 through September 30, 2020.

Hospital Outpatient Regulations and Notices

Hospital Outpatient Regulations and Notices

Long-Term Care Hospital PPS

Long-Term Care Hospital Prospective Payment System

Hospitals Articles

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So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?

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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 ...

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What is Medical Necessity and How Does Documentation Support It?

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We recently fielded the question, “What is medical necessity and how do I know if it's been met?" The AMA defines medical necessity as: It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...

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Type of Bill Code Structure (2018-08-30)

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The UB-04 claim form (also known as CMS 1450) is the standard facility and residential claim form used to report health claims. The Type of Bill is reported in Block No. 4 of the UB04 claim form. Type of bill codes are four-digit codes that describe the type of bill a ...

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Errors Billing Outpatient Services When Patient is also Inpatient

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The OIG recently reported that Medicare inappropriately paid acute-care hospitals for outpatient services provided to patients who were inpatients of another facility including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals.  CMS suggests using the following resources to ensure compliance: Medicare Inappropriately Paid Acute-Care Hospitals for ...

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Present on Admission POA Indicator

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This article will focus on the Present on Admission (POA) indicator which is used as a method of reporting whether a patient’s diagnoses are present at the time they are admitted to a facility. We’ll look at a few scenarios to determine the correct reporting of POA and the impact...

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Tools and Resources for Life Care Planners

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Life Care Planners play a vital and underappreciated including understanding the progression of a disease and lifetime clinical treatment options, research, delete (I combined this into the paragraph above) compiled into one easy-to-use resource. a unified providing a single destination for procedure coding coding to find information on...

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Pricing for ASC’s and APC’s

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For Medicare purposes, an Ambulatory Surgical Center Resources (ASC) is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission. ASC payment groups determine the amount that...

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TKAs to Outpatient What We Have Learned with Q1

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The release of the 2018 Final Rule for the Outpatient Prospective Payment System (OPPS) in November 2017 has created quite a stir across the orthopedic healthcare community. In what has been deemed a questionable decision, the Centers for Medicare and Medicaid Services (CMS) decided to remove Total Knee Arthroplasty...

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Maximizing Resources for ICD-10 Coding Audits

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From internal reviews to external inpatient coding audits, healthcare organizations nationwide are revisiting tried-and-true audit practices with ICD-10 coding quality in mind....

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Documentation for Inpatient Rehabilitation Facilities

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The Medicare Learning Network provides guidance on required documentation for Inpatient Rehabilitation Facilities (IRF).

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The Coder as the Last, Best Hope for the Right DRG

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f the story doesn't make sense, there is probably something missing. There are a variety of reasons why the DRG might not tell the story of the patient encounter....

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ICD-10-PCS Coding the Approach

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When coding surgical procedures, the approach is the technique you use to reach the site of the procedure, or how you get in to do the operation. The fifth character of PCS code is used to indicate the approach when using.  There are seven approaches. They are listed below with their ...

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Hospitals Webinars

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Coding Auditing Inpatient Evaluation and Management — A Hands-On Experience

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.

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