Hospital Billing tools offer many solutions to support hospital billing processes as well as auditing, payers' pricing, life planning and more....
Diagnosis Related Group (DRG) Codes
ICD-10-PCS Procedure Codes
ICD-10-PCS Procedure Codes Search
Find-A-Code's Tools & Resources
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.
ASC Topic Page
Ambulatory Surgical Center Links and Resources
APC Topic Page
Ambulatory Payment Classifications Links and Resources
Additional Links and Resources
Guidelines & Manuals
Search Links and Resources by Category
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 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
Inpatient Hospital Billing
Ch. 3 Medicare Claim Processing Manual
General Billing Requirements
Ch. 1 Medicare Claims Processing Manual
Part B Hospital Billing
Ch. 4 Medicare Claims Processing Manual
Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims
Ch. 8 Medicare Claims Processing Manual
Billing Requirements for OPPS
Billing Requirements for OPPS Providers with Multiple Service Locations
Critical Access Hospitals
Critical Access Hospitals Fees, Designations, Etc.
Select the title to see a summary and a link to the full article.
August 21st, 2019
So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?
Published August 21st, 2019|
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 ...
April 23rd, 2019
What is Medical Necessity and How Does Documentation Support It?
Published April 23rd, 2019|
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 ...
March 20th, 2019
Type of Bill Code Structure (2018-08-30)
Published March 20th, 2019 - Last Review/Update March 25th, 2019|
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 ...
November 29th, 2018
Errors Billing Outpatient Services When Patient is also Inpatient
Published November 29th, 2018|
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 ...
November 26th, 2018
Present on Admission POA Indicator
Published November 26th, 2018 - Last Review/Update November 29th, 2018|
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...
October 2nd, 2018
Tools and Resources for Life Care Planners
Published October 2nd, 2018|
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...
August 27th, 2018
Pricing for ASC’s and APC’s
Published August 27th, 2018|
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...
May 14th, 2018
TKAs to Outpatient What We Have Learned with Q1
Published May 14th, 2018 - Last Review/Update May 24th, 2018|
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...
March 27th, 2018
Maximizing Resources for ICD-10 Coding Audits
Published March 27th, 2018 - Last Review/Update April 12th, 2018|
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....
March 8th, 2018
Documentation for Inpatient Rehabilitation Facilities
Published March 8th, 2018 - Last Review/Update March 27th, 2018|
The Medicare Learning Network provides guidance on required documentation for Inpatient Rehabilitation Facilities (IRF).
February 12th, 2018
The Coder as the Last, Best Hope for the Right DRG
Published February 12th, 2018 - Last Review/Update April 12th, 2018|
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....
January 9th, 2018
ICD-10-PCS Coding the Approach
Published January 9th, 2018|
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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January 15th, 2019
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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