Billing and reimbursement

HCCs are the basis for risk adjustments for reimbursement models like Medicare Advantage, accountable care organizations (ACO), and other value-based purchasing measures such as Medicare Spending Per Beneficiary. Poor understanding and application of HCCs mean that a hospital’s patients may be much sicker in reality than they appear to be on paper. And that will hit reimbursement hard.

If we have a building that is across the parking lot from the main building of the hospital and connected with a hallway, is that considered on-campus?

This week’s Medicare updates include the delay of the effective date of the Advancing Care Coordination Through Episode Payment Models; Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model; a quarterly update to the Medicare Physician Fee Schedule database; ICD-10 coding revisions to National Coverage Determinations; and more!

Inpatient coding departments are likely familiar with integrating clinical documentation improvement (CDI) specialists into their processes. Crystal Stalter, CPC, CCS-P, CDIP, looks at how CDI techniques can benefit outpatient settings and what services and codes facilities should target. 

This week’s Medicare updates include Advance Care Planning implementation for OPPS claims, revision to State Operations Manual Appendix PP - incorporating revised Requirements of Participation for Medicare and Medicaid certified nursing facilities, and more!

Is modifier -PN used instead of or in addition to modifier -PO in a non-excepted department? Do we still need to add modifier -PO in general?

With a new year underway, providers likely need to get a handle on some key new modifiers, as well as important changes to an existing modifier and the deletion of a modifier that previously raised a lot of questions and operational concerns. 

The facility where I work will be charging for medication therapy management (MTM) services at its clinics. I am wondering whether we should bill MTM services with a 1500 or UB-04 form.

There are just three weeks left to submit your application for HCPro's call for speakers for the 2017 Revenue Integrity Symposium, to be held October 23–24, 2017, in Nashville, Tennessee. Complete your application now for a chance to join us at the podium.