The final rule for FY 2012 will be effective in about a week's time.
Recently CMS issued a final rule that'll update Medicare payment policies and rates for hospitals in FY 2012, an August 1 CMS release notes. The rule will affect Medicare payments to general acute care hospitals and long-term care hospitals for inpatient stays, supports endeavors to promote ongoing improvements in hospital care that'll lead to better patient results while taking a look at long-term health care cost growth, the agency mentions.
According to CMS Administrator Donald M. Berwick, M.D, "The final rule continues a payment approach that encourages hospitals to adopt practices that reduce errors and prevent patients from acquiring new illnesses or injuries during a hospital stay."
The final rule makes changes to payment policies and rates for acute care hospitals paid under the Inpatient Prospective Payment System (IPPS); so also hospitals paid under Long Term Care hospital Prospective Payment System.
This rule also boosts the Hospital Inpatient Quality Reporting (IQR) Program by placing more emphasis on avoiding health care-associated infections in general acute care hospitals.
The final rule will be effective for discharges taking place on or after October 1, 2011.
Under the FY 2012 IPPS, the agency had proposed a year-over-year reduction of 0.5% in payments to acute care hospitals. But then the agency finalized a cut of 2.0%, a decrease from 2.9% in FY 2011. This translates to $1.13 billion more in hospital payments in financial year 2012 than what was received in the previous year.
For more hospital billing and coding updates, sign up for a good coding resource like SuperCoder. Such a site has all the essential tools and resources you need to put your inpatient coding on track. Its DRG coder helps you get all of the inpatient coding data and tools you need to boost your payments and help you walk the compliance line.
Showing posts with label Hospital coding. Show all posts
Showing posts with label Hospital coding. Show all posts
Friday, September 23, 2011
Thursday, August 18, 2011
Hospital Coding Scenarios to Help You Avoid Denials
Hospital coding and billing mistakes can cost your hospitals thousands of dollars. Here are a couple of hospital billing & coding scenarios to help your understanding and save you from unnecessary denials.
Scenarios: After treating a patient in the office, our physician admitted her to the hospital later the same day. How should we go about this situation? Can we bill for the office visit and the first day of admission? Or do we just bill for the hospital stay?
Well, it all depends on whether your physician tends to the patient on the same day in the hospital.
Two face-to-face visits on the same date
If the physician tends to the patient in the hospital on the same day he saw her in the office, you are looking at two face-to-face visits on the same date. Go for only the proper initial hospital care code - (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ).
CPT coding guidelines ( Source "http://www.supercoder.com/cpt-codes/") lay down that all initial hospital care services that start in another place of location (say for instance the physician's office) should be combined and coded using the proper level of initial hospital care. As the 99221-99223 code will include the evaluation & management provided in the office, you will go for an initial hospital care code that includes the work done in both sites of the service.
Bill each encounter separately
However if your physician doesn't see the patient in the hospital until the next day, you should bill each encounter separately. Select the proper office visit code (99201-99205 or 99212-99215) for the visit on day one. After this add an initial hospital care code 99221-99223 for day two when the physician tends to the patient in the hospital for the first time.
Bear in mind: CPT uses initial hospital care codes to code the first hospital inpatient encounter by the admitting physician. Soon after that, you will report subsequent hospital care codes - 99231-99233 - until the date of discharge. After the physician discharges the patient, you will submit the proper hospital discharge day code (99238 or 99239, Hospital discharge day management ).
Scenarios: After treating a patient in the office, our physician admitted her to the hospital later the same day. How should we go about this situation? Can we bill for the office visit and the first day of admission? Or do we just bill for the hospital stay?
Well, it all depends on whether your physician tends to the patient on the same day in the hospital.
Two face-to-face visits on the same date
If the physician tends to the patient in the hospital on the same day he saw her in the office, you are looking at two face-to-face visits on the same date. Go for only the proper initial hospital care code - (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ).
CPT coding guidelines ( Source "http://www.supercoder.com/cpt-codes/") lay down that all initial hospital care services that start in another place of location (say for instance the physician's office) should be combined and coded using the proper level of initial hospital care. As the 99221-99223 code will include the evaluation & management provided in the office, you will go for an initial hospital care code that includes the work done in both sites of the service.
Bill each encounter separately
However if your physician doesn't see the patient in the hospital until the next day, you should bill each encounter separately. Select the proper office visit code (99201-99205 or 99212-99215) for the visit on day one. After this add an initial hospital care code 99221-99223 for day two when the physician tends to the patient in the hospital for the first time.
Bear in mind: CPT uses initial hospital care codes to code the first hospital inpatient encounter by the admitting physician. Soon after that, you will report subsequent hospital care codes - 99231-99233 - until the date of discharge. After the physician discharges the patient, you will submit the proper hospital discharge day code (99238 or 99239, Hospital discharge day management ).
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