HCPro.com: Briefings on APCs

Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules and how they impact hospital health information management systems and processes, coding, billing, and reimbursement.

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August 2008 (Volume 9, Issue 8)	view entire issue

Implement the new ESA transmittals in your hospital
Editor's note: In the July Briefings on APCs, part one of this two-part series featured Jennifer McPeek, BSN, OCN, discussing the national coverage determination (NCD) for erythropoiesis-stimulating agents (ESA) and educating different segments of your staff. This month, Angela Simmons, CPA, director of clinical revenue and reimbursement at the University of Texas, MD Anderson Cancer Center in Houston, presents best practices for the technical implementation of the ESA transmittal. Simmons is a nationally recognized expert in oncology Medicare reimbursement and a revenue cycle specialist.

Unraveling the costly inpatient-only procedures puzzle
Few CMS rules are as confusing as those for inpatient-only procedures performed in outpatient settings. Although CMS appears interested in learning when such procedures are justified, many believe the current process penalizes facilities that pass along the information. The basic rule for billing inpatient-only claims, reiterated in quarterly OCE updates, is as follows: If a physician performs a procedure on the inpatient-only list (OCE Addendum B) on an outpatient basis, and the procedure appears on a claim, the OCE denies the entire claim and returns it to the provider.

CMS Hospital Open Door Forum update
CMS hosted its most recent Hospital Open Door Forum (ODF) call June 12, during which it addressed several topics related to outpatient hospital services, including incident-to services and an update on patient status billing. Following is a summary of the call. A caller had a question about CMS' policy on clerical patient status errors corrected postdischarge (i.e., the registration clerk registers a patient as outpatient in the computer system, when in fact the patient was admitted as an inpatient). The caller was following up on this issue, which was discussed in a previous Hospital ODF.

CMS releases July I/OCE update
CMS released its July quarterly update to the I/OCE on May 30, effective July 7 ("July 2008 Integrated OCE Specifications Version 9.2"). Dave Fee, MBA, marketing manager for outpatient products at 3M Health Information Systems in Murray, UT, says this is a "fairly innocuous" update, following a characteristic pattern. However, Fee says, "there are a couple of gotchas that we need to be aware of."

Outpatient coders not exempt from the FY 2009 ICD-9 code changes: More revisions may come by October
The National Center for Health Statistics (NCHS) released its annual ICD-9-CM code changes May 30 for fiscal year (FY) 2009. However, additional revisions may be made before CMS publishes the inpatient prospective payment system (IPPS) final rule. The ICD-9-CM Coordination and Maintenance Committee suggested additional changes that CMS was unable to address before publishing the proposed rule. It is always a good idea to wait for the IPPS final rule before training your coding staff on the changes because it may include a laundry list of other new codes and revisions, says Shannon McCall, RHIA, CCS, CPC, director of HIM/coding for HCPro, Inc., in Glen Allen, VA.

Other recently-published articles from Briefings on APCs:

October Open Door Forum

Make determinations for self-administered drugs

Advisory panel speaks out against proposed decrease in separately payable drug reimbursement for 2009

Medicare publishes most Medically Unlikely Editsts

ICD-10 implementation timetable draws fire and support

Opinions vary on proposed payment changes to Type B EDs

Decipher integumentary codes for correct coding

Make determinations for self-administered drugs

Reminder: Medicare covers diabetes screening

Decipher integumentary codes for correct coding

Questions on E/M for hospital-based outpatient clinics

Eliminate unnecessary imaging services to meet planned APC payment reductions in 2009 OPPS proposed rule

Get ready now for ICD-10

CMS discusses MIPPA, incident-to services, and more

Prefabricated splint codes: No easy answers

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