The Integrated Outpatient Code Editor Summary of Data Changes document, published quarterly by CMS, is exceedingly valuable for hospital chargemaster maintenance. It is concise and lists all coding changes by their effective date. It is an essential for quarterly chargemaster updates.

The IOCE Summary of Data Changes document provides all quarterly changes related to:

APC CHANGES

I recently completed a consulting project for a client that required researching commercial payer coverage policies for a specific procedure. What I found was that, in addition to a list of relevant CPT codes for the particular service I was researching, there was a host of HCPCS “S” codes that were included in some of the coverage policies. It occurred to me that these are not codes you come across every day, so I took the opportunity to refresh my understanding of these codes. I’ll share with you what I learned.

Questions, questions, some answers, but more questions as I reflect on the 2010 ICD-10 AHIMA Summit that I attended earlier this week. One of the big questions is are YOU ready for this big change in healthcare and have you started to PREPARE? ICD-10 will affect all aspects in healthcare (payers, providers, vendors, clearinghouses, third party administrators, independent laboratories, employers, and researchers) to name a few. 

To assist customers with understanding issues being investigated by the Recovery Audit Contractor, MediRegs has launched a new set of resources.

RAC Issues Comparison Chart

On the left-hand navigation pane of the Coding & Revenue Resource Center, the Audit & Revenue Resource Center, and the Regulation & Reimbursement Suite, you will find a new RAC ISSSUES link. This sortable table outlines the types of issues being investigated by the 4 Recovery Audit Contractors.

The 2010 ICD-10 Codebook is available in all Regulatory and Coding Suite products.   This is a breakdown of over 2000 pages of coding, mapping, and guidance information reformatted into an easy to search and browse book.  As always, the 2009 archive version has been saved in the Archives libraries - available with other codebook archives in the  Audit & Revenue Resource Center an Regulation & Reimbursement Suite.  If you create bookmarks in the 2009 book, they should now autom

Are you participating in this important program?  We've updated Code Explorer in Coding & Revenue Resource Center and Audit & Revenue Resource Center to make flagging PQRI codes a breeze.   The 2010 Specifications Manual contains details for each specific measure - simply click the GUIDANCE link from Code Explorer to see which measures any particular code falls into and tunnel in for details.  Access the 2010 PQRI&nbsp

The micro lab has numerous “add on” procedures that are routinely performed to complete the culture report. Frequently, add on charges are never captured. There are several reasons for this – some process driven (such as bill drop dates coming too soon for the completion of all testing) and human errors (not submitting charges in a timely manner). One BIG reason is simply because bacteria do not grow at the whim of human time lines.

CMS issues its changes to the Physician Fee Schedule quarterly, but how often do you have the chance to analyze it and review it? With over 15000 lines filling a spreadsheet, comparing each quarter’s changes can be a daunting and time consuming task. Are you aware that MediRegs does this for you? They issue a difference report every quarter that highlights the changes between the current version and the last quarter’s version. Look for the file called “Difference Report” and “MediRegs created.”

A conversation was recently had with a CMS representative regarding their policy and billing instructions associated with observation hours and services in situations when a patient is admitted as an inpatient but is subsequently found to be only eligible for observation; thus billed as an outpatient on the UB-04 reporting the Condition code 44.

Coding professionals face increasing challenges to code claims accurately. Facilities can help ensure documentation integrity and coding accuracy by establishing and managing an effective query process. The importance of complete documentation in the patient’s health record cannot be overstated; without such documentation accurate coding cannot be assigned.