A LOOK INSIDE THE CHARGEMASTER
|
|
- Erin McBride
- 7 years ago
- Views:
Transcription
1 A LOOK INSIDE THE CHARGEMASTER
2 Objectives What is the chargemaster? What is the connection between reimbursement and the chargemaster? What is the connection between the chargemaster and billing? 1
3 Definition of chargemaster Also known as the charge description master (CDM) Tool used to charge for procedures, services and supplies provided to patients Updated frequently as departments add charges for new services or perform new procedures or terminate services Updated for coding and price changes 2
4 UB04 Code The UB04 code means Universal Billing Code The three digit UB04 code is also known as the revenue code The UB tells the payer where the service was performed or what type of service was provided. For example: 324 means Radiology, 420 is Physical Therapy and 750 is Endoscopy 3
5 CPT and HCPCS Codes The CPT code is a key field in the charge code CPT stands for Current Procedural Terminology and is copyrighted by the American Medical Association Clinic Visit, Established Patient, Level 3 HCPCS means Healthcare Common Procedure Coding System and is authored by Medicare and the BC/BS Association C1751 Infusion Catheter 4
6 CPT and HCPCS Codes CPT codes describe procedures HCPCS codes are often used for new devices, supplies and drugs (and occasionally for new emerging procedures) CPT and HCPCS codes are updated annually 5
7 Sample CPT and HCPCS codes CPT / HCPCS SIM Description SIM COLONOSCOPY AMNIOCENTESIS PUNCTURE SPINAL LUMBAR US ABDOMEN LIMITED DRUG SCREEN URINE INJECTION IM/SUBCUTANEOUS EEG PT EXERCISE THERAPEUTIC 15 MIN C1300 HYPERBARIC OXYGEN FULL BODY 30 MIN C1714 CATHETER ATHERECTOMY S9444 PARENTING CLASS PER SESSION
8 CPT and HCPCS Codes CPT and HCPCS codes are assigned to the CDM based on the description of the procedure or service performed Not all charge codes have a CPT/HCPCS code, i.e., room and bed, supplies Assigning the wrong CPT could result in incorrect charges and payments 7
9 APCs and OPPS Majority of outpatient reimbursement is tied to the CPT code In 2000, Medicare began reimbursing hospitals through the APC system. APC stands for Ambulatory Payment Classification Replaces prior OP reimbursement methods APCs are often referred to as OPPS Outpatient Prospective Payment System System driven by the CPT code 8
10 Payment methodologies First, payment was based on fee schedule All services (CPTs) were separately paid Then, payment based on APC Incentive to more efficiently use resources because payment based on APC rather than CPT Then, Composite APCs Incentive to even more efficiently use resources because one payment for services within same Composite APC 9
11 Recent Changes to OPPS Service families proposed but not implemented 2008 More packaging/bundling of services suggested Composite APCs added for imaging Looking forward Move toward episode based payment. Would be similar to DRGs 10
12 Composite APC Methodology CMS will provide single payment for 2 or more major independent procedures performed together during a single session Five new APCs for composite payment (ultrasound; CT/CTA; MRI/MRA) 11
13 Charging for composite APCs Charging does not change for composite procedures Ex. CT Abdomen and CT Pelvis continue to be separately charged so both CPTs appear on claim. In the past there would be payment for both CPTs. With composite APC rate, there is one payment at a higher rate than the single procedure but at a lower rate than if the two were paid separately 12
14 CCI Edits CCI stands for Correct Coding Initiative Prevents hospitals from charging for procedures that are considered inherent to another procedure or a component of another procedure Prevents charging for mutually exclusive procedures - those not reasonably performed together At the least, component coding and mutually exclusive codes wouldn t get past the CCI edits, which slows down the revenue cycle. At the worst, it could result in overpayment 13
15 Editing for Correct Coding Claim Scrubbing is a process that uses internal edits to catch and correct coding errors before the claim goes to the payer in order to avoid the payer edits Payer edits will catch the errors and return the claim to the provider delaying payment 14
16 Annual coding updates CMS (Center for Medicare and Medicaid Services) updates are January 1 as well as quarterly Review transmittals from CMS detailing changes in coding and billing requirements AMA publishes new, revised and deleted CPT codes annually After communication with departments, Charge Analysis enters changes into chargemasters 15
17 Department role in annual updates Understand changes and determine applicability to their department Educate staff on changes in charging Update charge vouchers and department charging systems Provide acknowledgement indicating implementation of new codes, policies & procedures, etc. 16
18 Compliance Paramount when talking about the CDM CDM compliance is charging correctly, fairly and in accordance with national, state and local health care regulations Several compliance risks in the charge process 17
19 Compliance 1. Was the service provided? Cannot charge for something that was not provided 2. Is there documentation to support the charge? You ve probably heard the expression, if it s not documented, then we didn t do it! 3. Is the most specific CPT being used? 18
20 Compliance 4. Is the item chargeable? Routine supplies such as bedpans, blankets, thermometers, bandaids, needles, syringes (bulk supplies) and equipment such as beds and IV pumps are not chargeable to patients 5. Are we charging all patients the same regardless of payer? 19
21 Charge Process After new CPT added to CDM it is available to be entered as a charge Department adds to charge voucher/system Be sure correct account is charged Charges to be entered within 5 days of discharge or outpatient visit Number of days does not increase for weekends or holidays Claim drops to HIS for entry into your billing system Claim is prepared for submission; edits are complete 20
22 Claim example - Outpatient 21
23 Questions? 22
Charge Master Comprehensive Audit
The PARA charge master audit process utilizes the PARA Data Editor (PDE) to create a series of focused screens and reports utilized by the PARA HIM Coding Staff to identify and correct charge master errors,
Chargemaster Basics and Beyond
Chargemaster Basics and Beyond Marilyn Hart Niedzwiecki CPA, MBA, RN, CPC, CPC H Director Revenue Integrity Children's Memorial Hospital, Chicago, IL Children s Memorial Hospital Chicago 247 Bed Children
CODING SHEETS CHRONIC INTRACTABLE PAIN MANAGEMENT. Effective January 1, 2011 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE
CODING SHEETS CHRONIC INTRACTABLE PAIN MANAGEMENT Effective January 1, 2011 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE Phone: 800-609-1108 Email: codmanpump@aol.com Fax: 303-703-1572
CODE AUDITING RULES. SAMPLE Medical Policy Rationale
CODE AUDITING RULES As part of Coventry Health Care of Missouri, Inc s commitment to improve business processes, we are implemented a new payment policy program that applies to claims processed on August
CODING SHEETS CHRONIC INTRACTABLE SPASTICITY. Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE
CODING SHEETS CHRONIC INTRACTABLE SPASTICITY Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE Phone: 800-609-1108 Email: codmanpump@aol.com Fax: 303-703-1572 CODMAN
ICD-10 Frequently Asked Questions
These frequently asked questions cover the topics most providers want to know about our ICD-10 preparation. If you have other questions, please email psc@healthalliance.org. ICD-10 Frequently Asked Questions
Health Care Finance 101
Alaska Health Care Commission Health Care Finance 101 Ken Tonjes CFO PeaceHealth Ketchikan Medical Center June 20, 2013 Basics: Glossary of Terms Common Financial Terminology Gross Charges (Revenue) Total
Supply Policy. Approved By 1/27/2014
Supply Policy Policy Number 2014R0006A Annual Approval Date 1/27/2014 Approved By National Reimbursement Forum United HealthCare Community & State Payment Policy Committee IMPORTANT NOTE ABOUT THIS You
Chargemaster Nuts and Bolts. By Cathy Meeter, R.N. BSN CMAS CDM Director, Sutter Health
Chargemaster Nuts and Bolts By Cathy Meeter, R.N. BSN CMAS CDM Director, Sutter Health Disclaimer The comments expressed throughout this presentation are my opinions, predicated on my interpretation of
2006 Provider Coding/Billing Information. www.novoseven-us.com
2006 Provider Coding/Billing Information 2 3 Contents About NovoSeven...2 Coverage...4 Coding...4 Reimbursement...8 Establishing Medical Necessity and Appealing Denied Claims...10 Claims Materials...12
ZEPHYRLIFE REMOTE PATIENT MONITORING REIMBURSEMENT REFERENCE GUIDE
ZEPHYRLIFE REMOTE PATIENT MONITORING REIMBURSEMENT REFERENCE GUIDE Overview This guide includes an overview of Medicare reimbursement methodologies and potential coding options for the use of select remote
I. Hospitals Reimbursed Under Medicare's Prospective Payment System. A. Hospital Inpatient Prospective Payment System
PROCEDURAL GUIDANCE on HOSPITAL and FACILITY REIMBURSEMENT UNDER INDIANA'S WORKERS COMPENSATION PROGRAM Effective for procedures rendered on and after July 1, 2014 by Trudy H. Struck I. Hospitals Reimbursed
University of Mississippi Medical Center. Access Management. Patient Access Specialists II
Financial Terminology in Access Management University of Mississippi Medical Center Access Management Patient Access Specialists II As a Patient Access Specialist You are the FIRST STAGE in the Revenue
NOVOSTE BETA-CATH SYSTEM
HOSPITAL INPATIENT AND OUTPATIENT BILLING GUIDE FOR THE NOVOSTE BETA-CATH SYSTEM INTRAVASCULAR BRACHYTHERAPY DEVICE This guide is intended solely for use as a tool to help hospital billing staff resolve
The following is a description of the fields that appear on the results page for the Procedure Code Search.
Fee Schedule Legend Updated: 9/21/2015 The following is a description of the fields that appear on the results page for the Procedure Code Search. Procedure Code the five-character procedure code as listed
Physical Therapy (PT) Modalities and Evaluation
Status Active Reimbursement Policy Section: Rehabilitative Services Policy Number: RP - Rehabilitative Services - 001 PT Modalities and Evaluation Effective Date: June 1, 2015 Physical Therapy (PT) Modalities
Modifier -52 Reduced Services
Manual: Policy Title: Reimbursement Policy Modifier -52 Reduced Services Section: Administrative Subsection: Policy Number: RPM 003 Date of Origin: Insert date approved Last Updated: same IMPORTANT STATEMENT
Information Integrity in the Revenue Cycle! Order Entry, All Subsystems and The Charge Description Master
Information Integrity in the Revenue Cycle! Order Entry, All Subsystems and The Charge Description Master 2011 Our Philosophy: We are a firm believer in information integrity. Therefore we perform on or
Corporate Reimbursement Policy
Corporate Reimbursement Policy Code Bundling Rules Not Addressed in ClaimCheck or Correct Coding Initiative File Name: code_bundling_rules_not_addressed_in_claim_check Origination: 6/2004 Last Review:
Modifier Reference Policy
Policy Number 2016R0111C Annual Approval Date Modifier Reference Policy 11/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for
Blue Cross Blue Shield of Michigan
Medicare Plus Blue Home infusion therapy Applies to: Medicare Plus Blue PPO SM Medicare Plus Blue Group PPO SM X Both Home infusion therapy Home infusion therapy is the continuous, slow administration
Ambulatory Surgery Center Coding and Payment Guide 2015
Targeted Drug Delivery Ambulatory Surgery Center Coding and Payment Guide 2015 Flowonix Medical has compiled this coding information for your convenience. This information is gathered from third party
Medicare Part B vs. Part D
Medicare Part B vs. Part D 60889-R8-V1 (c) 2012 Amgen Inc. All rights reserved 2 This information is provided for your background education and is not intended to serve as guidance for specific coding,
Glossary. Adults: Individuals ages 19 through 64. Allowed amounts: See prices paid. Allowed costs: See prices paid.
Glossary Acute inpatient: A subservice category of the inpatient facility clams that have excluded skilled nursing facilities (SNF), hospice, and ungroupable claims. This subcategory was previously known
Charge Master Supply Categorization General Position Paper Apex Medical Center 1 Anywhere, USA
Charge Master Supply Categorization General Position Paper Apex Medical Center 1 Anywhere, USA Introduction The proper categorization of supplies has become a difficult issue in light of both payment system
Routine Venipuncture and/or Collection of Specimens
Manual: Policy Title: Reimbursement Policy Routine Venipuncture and/or Collection of Specimens Section: Laboratory & Pathology Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM012 Last Updated:
Reimbursement for Physician- Administered Drugs:
Reimbursement for Physician- Purchased and Physician- Administered Drugs: Understanding the Buy and Bill Process 60889-R5-V1 This information is provided d for your background education and is not intended
IWCC 50 ILLINOIS ADMINISTRATIVE CODE 7110 7110.90. Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule
Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule a) In accordance with Sections 8(a), 8.2 and 16 of the Workers' Compensation Act [820 ILCS 305/8(a), 8.2 and 16] (the Act),
New Patient Visit. UnitedHealthcare Medicare Reimbursement Policy Committee
New Patient Visit Policy Number NPV04242013RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 12/16/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to
Medical Management Program
Section 7. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.
Perioperative Charge Process
There are eight components to the charge process for surgical services: 1. Pre op prep and care 2. Anesthesia 3. Operating room time charges 4. Equipment charges 5. Recovery / Post Anesthesia Care Unit
Rotator Cuff Repair Surgical Procedures
Rotator Cuff Repair Surgical Procedures 2011 Reimbursement and Coding Reference Guide for Physicians and Hospitals This coding reference guide is intended to illustrate the common CPT * codes, ICD-9 CM
E/M Services and Drug Infusion Codes
Statement of the Problem E/M Services and Drug Infusion Codes Recently, the American College of Gastroenterology (ACG), American Gastroenterological Association (AGA) and American Society for Gastrointestinal
The following references are used throughout the billing scenarios that follow:
11 Part B Billing Scenarios for PTs and OTs The following billing scenarios formerly appeared on the Frequently Asked Questions (FAQ) website and on the Therapy Medlearn website as "11 FAQs" - posted 9/13/02
Regulatory Compliance Policy No. COMP-RCC 4.07 Title:
I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.07 Page: 1 of 7 This policy applies to (1) any Hospital in which Tenet Healthcare Corporation or an affiliate owns a direct or indirect equity interest
60889-R5-V1. Billing a Miscellaneous/
60889-R5-V1 Billing a Miscellaneous/ Unclassified HCPCS Code This information is provided d for your background education and is not intended to serve as guidance for specific coding, billing, and claims
BILLING FACILITY FEES
BILLING FACILITY FEES Medicare ASC Payment Groups Once an ASC is approved for Medicare participation, the ASC can only be reimbursed for procedures that are on a list of procedures that Medicare will reimburse
BULLETIN CHANGES AND CORRECTIONS TO THE MISSISSIPPI FEE SCHEDULE
Mississippi Workers Compensation Commission 1428 Lakeland Drive / Post Office Box 5300 Jackson, Mississippi 39296-5300 (601) 987-4268 http://www.mwcc.state.ms.us Mike Marsh, Chairman Barney J. Schoby,
AHIMA Curriculum Map Health Information Management Associate Degree Approved by AHIMA Education Strategy Committee February 2011
HIM Associate Degree Entry Level Competencies (Student Learning Outcomes) I. Domain: Health Data Management A. Subdomain: Health Data Structure, Content and Standards 1. Collect and maintain health data
DERMABOND Portfolio 2012 LACERATION REPAIR REIMBURSEMENT GUIDE
2012 LACERATION REPAIR REIMBURSEMENT GUIDE ETHICON, INC. IS PLEASED TO PROVIDE THIS LACERATION REPAIR REIMBURSEMENT GUIDE AS A RESOURCE FOR HEALTHCARE PROVIDERS. This guide is intended for informational
Outpatient Prospective Payment System (OPPS) Project. Understanding Ambulatory Payment Classification (APC)
Outpatient Prospective Payment System (OPPS) Project Understanding Ambulatory Payment Classification (APC) 1 Purpose and Objectives After this presentation, you will have a better understanding of OPPS
SYLLABUS. Credits: 4 Lecture Hours: 3 Lab/Studio Hours: 2
Code: HITC 224 Title: Coding & Classification Systems II Division: Health Sciences Department: Allied Health Course Description: In this course the student will study the principles of coding and classification
Effective Denials Management
Effective Denials Management Audio Seminar/Webinar April 16, 2009 Practical Tools for Seminar Learning Copyright 2009 American Health Information Management Association. All rights reserved. Disclaimer
Local Coverage Article: Cardiovascular Stress Testing (A53123)
Local Coverage Article: Cardiovascular Stress Testing (A53123) Contractor Information Contractor Name Novitas Solutions, Inc. Article Information General Information Article ID A53123 Original ICD-9 Article
Q: What is your organization s approach for complying with the ICD-10 mandate?
ICD-10 Provider Frequently Asked Questions This FAQ document will continue to be reviewed and updated frequently in order to provide the most current and pertinent information. ValueOptions ICD-10 Planning
Partial Hospitalization Program Interim Billing Guidelines
Partial Hospitalization Program Interim Billing Guidelines March 2013 1449_0313 Today s Presenters Christine Janiszcak, Provider Outreach & Education Consultant Pat Zachmann, Provider Outreach & Education
Medical, Surgical, and Routine Supplies (including but not limited to 99070)
Manual: Policy Title: Reimbursement Policy Medical, Surgical, and Routine Supplies (including but not limited to 99070) Section: Administrative Subsection: none Date of Origin: 1/1/2002 Policy Number:
Preparing for the Conversion from ICD-9 to ICD-10: What You Need to Be Doing Today
Preparing for the Conversion from ICD-9 to ICD-10: What You Need to Be Doing Today Currently in the United States, ICD-9 is the code set used to report diagnoses and inpatient procedures. ICD-9 stands
GUIDE TO HOME HEALTH DIAGNOSIS CODES
GUIDE TO HOME HEALTH DIAGNOSIS CODES Proper selection of diagnoses codes for the Medicare OASIS Assessment The process of selecting correct diagnosis codes for the OASIS Start of Care, Re-Certification
CONNECTIONS APPEALING A CODE DENIED BY CLINICAL EDIT
APPEALING A CODE DENIED BY CLINICAL EDIT Providers may appeal denials of edited codes by submitting a clinical edit (CE) inquiry. The Clinical Edit Inquiry form may be found on ProvLink by clicking on
Medicare Outpatient Therapy Billing
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services R Medicare Outpatient Therapy Billing August 2010 / ICN: 903663 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare
Intraoperative Nerve Monitoring Coding Guide. March 1, 2010
Intraoperative Nerve Monitoring Coding Guide March 1, 2010 Please direct any questions to: Kim Brew Manager Reimbursement and Therapy Access Medtronic ENT (904) 279-7569 Rev 9/10 KB TO OUR PARTNERS IN
Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide for American Medical Security Life Insurance Company
Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide for American Medical Security Life Insurance Company Insureds 2009 Contents How to contact us... 2 Our claims process...
Physician Coding and Payment Guide 2015
Targeted Drug Delivery Physician Coding and Payment Guide 2015 Flowonix Medical has compiled this coding information for your convenience. This information is gathered from third party sources and is subject
Rehabilitation Compliance Risks. Agenda - Rehabilitation Compliance Risks
Rehabilitation Compliance Risks Christine Bachrach, Chief Compliance Officer, HealthSouth Catherine Niland, Organizational Integrity Manager, Trinity Health www.hcca-info.org 888-580-8373 Agenda - Rehabilitation
Complex 2015 Changes to Radiation Oncology Coding
Complex 2015 Changes to Radiation Oncology Coding The Centers for Medicare & Medicaid Services (CMS) issued its Final Rule on October 31 outlining the codes it would recognize in calendar year (CY) 2015.
uncovering pharmacy department risks and opportunities
Gary R. Fong Randy Wiitala Frederick Stodolak REPRINT MAY 2011 healthcare financial management association www.hfma.org uncovering pharmacy department risks and opportunities Increased audit exposure,
Appendix A WORK PROCESS SCHEDULE HIM (HEALTH INFORMATION MANAGEMENT) HOSPITAL CODER O*NET-SOC CODE: 29-2071.00 RAPIDS CODE: TBD
Appendix A WORK PROCESS SCHEDULE HIM (HEALTH INFORMATION MANAGEMENT) HOSPITAL CODER O*NET-SOC CODE: 29-2071.00 RAPIDS CODE: TBD This schedule is attached to and a part of these Standards for the above
Inpatient or Outpatient Only: Why Observation Has Lost Its Status
Inpatient or Outpatient Only: Why Observation Has Lost Its Status W h i t e p a p e r Proper patient status classification affects the clinical and financial success of hospitals. Unfortunately, assigning
Modifiers 58, 78, and 79 Staged, Related, and Unrelated Procedures
Manual: Policy Title: Reimbursement Policy Modifiers 58, 78, and 79 Staged, Related, and Unrelated Procedures Section: Modifiers Subsection: None Date of Origin: 9/22/2004 Policy Number: RPM010 Last Updated:
How to Incorporate Bundling into the Revenue Cycle
How to Incorporate Bundling into the Revenue Cycle Len Kalm HCA VP Managed Care Shannon Dauchot Parallon Business Solutions SVP Corporate Operations Revenue Cycle 1 Headquarters based in Nashville, TN
Reporting of Devices and Leads When a Credit is Received
Reporting of Devices and Leads When a Credit is Received Cardiac Rhythm Management and Electrophysiology Updated January 2014 Medicare Reporting Requirements For Full or Partial Credits of Devices and
New York. UnitedHealthcare Community Plan Claims System Migration Provider Quick Reference Guide. Complete Claims. Our Claims Process
Our Claims Process Here are a few steps to ensure you receive prompt payment: 1 Review and copy both sides of the member s ID card. members receive an ID card containing information that helps you process
12/1/2010. A Brief Introduction. Ron Stunz, M.D., F.A.C.E.P. Medical Director, MMP Co-Chair, PaACEP Reimbursement Committee
E.D. Facility Coding A Brief Introduction Ron Stunz, M.D., F.A.C.E.P.,, Medical Director, MMP Co-Chair, PaACEP Reimbursement Committee 1 Directors, Know Your Audience and Your Players $$$$$$$$$$$$$$$$$$$$$$$$$$$$$
KYPHON. Reimbursement Guide. Physician Reimbursement. Balloon Kyphoplasty Procedure. ICD-9-CM Diagnosis Codes. CPT Codes and Payment
KYPHON Balloon Kyphoplasty Procedure Reimbursement Guide ICD-9-CM Diagnosis Codes Providers should report the ICD-9-CM diagnosis code that most accurately describes the patient s condition. Please refer
Surgeon and Radiological Services Billing for Laparoscopic Adjustable Gastric Band Procedures
Surgeon and Radiological Services Billing for Laparoscopic Adjustable Gastric Band Procedures Table 1: Surgeon Billing for Laparoscopic Adjustable Gastric Band Procedures 2012 Medicare Payment 2 43770
National Council for Behavioral Health
National Council for Behavioral Health Preparing your Organization for ICD-10 Implementation Presented by: Michael D. Flora, MBA, M.A.Ed, LCPC, LSW Senior Operations and Management Consultant David R.
Good News for Rehabilitation Physicians
Good News for Rehabilitation Physicians by CHERILYN G. MURER, J.D., C.R.A. For physicians practicing rehabilitative medicine, recent regulations and program memoranda issued by CMS and the Department of
Medi-Pak Advantage: Frequently Asked Questions
Medi-Pak Advantage: Frequently Asked Questions General Information: What Medicare Advantage product is Arkansas Blue Cross Blue Shield offering? Arkansas Blue Cross and Blue Shield has been approved by
Diagnostic Radiology. Computed Tomographic Colonography 74261-74263
2010 CPT Code Update *(Current Procedural Terminology 2009 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.) To assist in preparation
September 19, 2012. Dialysis Facility Reimbursement
September 19, 2012 Dialysis Facility Reimbursement Current EGID Reimbursement Dialysis providers are currently reimbursed under the outpatient portion of EGID s facility contract. Network providers receive
HITT 2335 AUSTIN COMMUNITY COLLEGE Semester: Course Dates. HITT 2335 Coding and Reimbursement Methodologies
HITT 2335 AUSTIN COMMUNITY COLLEGE Semester: Course Dates PROGRAM: COURSE NUMBER: Health Information Technology HITT 2335 Coding and Reimbursement Methodologies COURSE TIME/LOCATION: FACULTY NAME: OFFICE
Proprietary information of MedCost, LLC. Do not distribute or reproduce without express permission of MedCost.
North Carolina Health Insurance Institute October 10-11, 2013 Greensboro, NC 1 What s New With MedCost? We are celebrating 30 years of being in business. 2 A New Web Site and Logo 3 Enhanced Information
AHIMA Curriculum Map Health Information Management Associate Degree Approved by AHIMA Education Strategy Committee February 2011
AHIMA Curriculum Map Health Information Management Associate Degree Approved by AHIMA Education Strategy Committee February 2011 HIM Associate Degree Entry-Level Competencies (Student Learning Outcomes)
UNRAVELING THE MYSTERIES OF SPLIT
UNRAVELING THE MYSTERIES OF SPLIT BILLING FOR HOSPITAL-BASED DEPARTMENTS AND CLINICS AUGUST 23, 2012 JEAN RUSSELL, MS, RHIT 518-369-4986 JRUSSELL@EPOCHHEALTH.COM AGENDA Based on Medicare and NY Medicaid
Incident To Services
Policy Number INT04242013RP Approved By Incident To Services UnitedHealthcare Medicare Committee Current Approval Date 11/18/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable
CODING GUIDELINES FOR CONTRACEPTIVES. Updated for ICD-10 CM (post October 1, 2015)
CODING GUIDELINES FOR CONTRACEPTIVES Updated for ICD-10 CM (post October 1, 2015) TABLE OF CONTENTS ICD-10 CM Diagnosis Codes: Encounter for contraception page 2 LARC: Coding for IUD Insertion and Removal
Institutional Claim Billing Reimbursement. HP Provider Relations/October 2013
Institutional Claim Billing Reimbursement HP Provider Relations/October 2013 Agenda Objectives Institutional Claim Basics Inpatient Claim Payment Outpatient Claim Payment Enhanced Code Auditing Billing
A New Hospital Outpatient Payment Method for Rhode Island Medicaid
A New Hospital Outpatient Payment Method for Rhode Island Medicaid Frequently Asked Questions The Rhode Island Medicaid program will move to a new method of paying for hospital outpatient services based
eskbook Emerging Life Sciences Companies second edition Chapter 18 Medicare Reimbursement for Drugs and Devices
eskbook Emerging Life Sciences Companies second edition Chapter 18 Medicare Reimbursement for Drugs and Devices Chapter 18 MEDICARE REIMBURSEMENT FOR DRUGS AND DEVICES Coverage Coding There is no reimbursement
Chemotherapy Administration, Hydration and Therapeutic, Prophylactic, and Diagnostic Injections and Infusions
Chemotherapy Administration, Hydration and Therapeutic, Prophylactic, and Diagnostic Injections and Infusions Table of Contents: Overview... Professional Services... 2 Services... 4 Overview Chemotherapy
Coding Injections and Infusions
Coding Injections and Infusions Audio Seminar/Webinar January 31, 2008 Practical Tools for Seminar Learning Copyright 2008 American Health Information Management Association. All rights reserved. Disclaimer
http://health-information.advanceweb.com/editorial/content/printfriendly.aspx?cc=211...
Page 1 of 6 HIM Abbreviations ADVANCE explains what all those letters mean. ADVANCE explains what all those letters mean. In HIM, there seems to be an abbreviation for everything--policies, agencies, rules
The Basics of Medicaid Precertification. Revised June 2015 PA/UM Department
The Basics of Medicaid Precertification Revised June 2015 PA/UM Department Medicaid Precertification Basics Conditions of reimbursement What needs precertification? Who is responsible? Types and time frames
Payment Policy. Evaluation and Management
Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions
Durable Medical Equipment, Orthotics and Prosthetics Multiple Frequency Policy
Policy Number REIMBURSEMENT POLICY Durable Medical Equipment, Orthotics and Prosthetics Multiple Frequency Policy 2015R0109C Annual Approval Date 7/8/2015 Approved By Payment Policy Oversight Committee
Medicare Outpatient Prospective Payment System
Medicare Outpatient Prospective Payment System Payment Rule Brief Calendar Year 2015 Final Rule Overview The final calendar year (CY) 2015 payment rule for the Medicare Outpatient Prospective Payment System
Modifiers XE, XS, XP, XU, and 59 - Distinct Procedural Service
Manual: Policy Title: Reimbursement Policy Modifiers XE, XS, XP, XU, and 59 - Distinct Procedural Service Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM027 Last Updated:
Billing Manual for In-State Long Term Care Nursing Facilities
Billing Manual for In-State Long Term Care Nursing Facilities Medical Services North Dakota Department of Human Services 600 E Boulevard Ave, Dept 325 Bismarck, ND 58505 September 2003 INTRODUCTION The
istent Trabecular Micro-Bypass Stent Reimbursement Guide
istent Trabecular Micro-Bypass Stent Reimbursement Guide Table of Contents Overview Coding 2 3 Coding Overview Procedure Coding Device Coding Additional Coding Information Coverage Payment 8 9 Payment
2016 Mayo Clinic Health System Eau Claire Charge and Reimbursement Information for Health Care Consumers Required by 2009 Wisconsin Act 146
2016 Mayo Clinic Health System Eau Claire Charge and Reimbursement Information for Health Care Consumers Required by 2009 Wisconsin Act 146 The Wisconsin Act 146 seeks to make cost and charge information
Contract Management and Analysis
Contract management and analysis is one of the most critical focus points. Hospital Financial Managers need a tool to manage, evaluate and optimize reimbursement to achieve the required returns. The PARA
Observation Care Evaluation and Management Codes Policy
Policy Number REIMBURSEMENT POLICY Observation Care Evaluation and Management Codes Policy 2016R0115A Annual Approval Date 3/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT
Adding Value to. Provider Compensation. June 13, 2016. Healthcare Strategy Group OHA Presentation 2016. Adding Value to. Physician Compensation
Provider Compensation June 13, 2016 1 Who are We? About (HSG) Hospital-physician integration specialists since 1999 Strategic, best practice approach to employed physician networks and independent physician
Preventive Medicine and Screening Policy
REIMBURSEMENT POLICY Policy Number 2015R0013C Preventive Medicine and Screening Policy Annual Approval Date 3/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT
School of Health Professions Department of Health Services Administration Health Information Management
School of Health Professions Department of Health Services Administration Health Information Management COURSE NUMBER and TITLE: COURSE DESCRIPTION: HIM 460: Coding and Classification Systems Ambulatory
Corporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: infusion_therapy_in_the_home 3/1998 2/2016 2/2017 2/2016 Description of Procedure or Service Home infusion
Bundled Episodes of Care Payments
Index: How do Bundled Payments Differ from Capitation Payments? Steps to Implementing Bundled Payments Case Studies of Bundled Payments in California How Do I Implement Bundled Payments? Benefits and Risk
COURSE INFORMATION FORM
DATE SUBMITTED 4/4/14 CATALOG NO. HIM 214 DATE DICC APPROVED 02/2015 DATE LAST REVIEWED 11/4/13 DISCIPLINE COURSE TITLE COURSE INFORMATION FORM Health Information Management Healthcare Reimbursement Methodologies
Radiology Prior Authorization Program Frequently Asked Questions for the UnitedHealthcare Community Plan
Radiology Prior Authorization Program Frequently Asked Questions for the UnitedHealthcare Community Plan 1. What is the UnitedHealthcare Radiology Prior Authorization Program? Acting on behalf of our Medicaid