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Errors Billing Outpatient Services When Patient is also Inpatient

Pricing for ASCs and APCs


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MS-DRG Grouper

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

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DRG Grouper Tutorial

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Validate using NCCI edits for errors in code selection.

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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.

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


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


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


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


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


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


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


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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Documentation for Inpatient Rehabilitation Facilities


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


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


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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Select the webinar title to view a summary and link to the webinar video.

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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