You've been given time: Get your house in order
You've been given time: Get your house in order
Are coders up to snuff?
Take advantage of the fact that your outpatient program has additional time to prepare for ambulatory patient classifications (APCs), says Lois Yoder, ART, CCS, president of The enVision Group, a resource management and consulting firm for hospital-based services in Naples, FL. Yoder has worked with the outpatient prospective payment system since states began implementing it for Medicaid.
On Sept. 8, the Health Care Financing Administration published its proposal for a hospital outpatient prospective payment system in the Federal Register. The implementation date, which originally was scheduled for Jan. 1, 1999, has been moved to no sooner than April 2000. The implementation date will be preceded by a 90-day notice.
"Look at the operational aspects of departments like registration, coding, billing, chargemasters, and documentation," says Yoder. "Make sure they're running efficiently. Make sure you have policies and procedures in place to ensure charting is done in a timely manner."
Make sure charges have definition to them, she emphasizes. "Make sure [coders] understand what cost items, such as supplies, are part of a bundled service or not," Yoder says. "Make sure coders are able to handle the ICD-9 and CPT coding when necessary."
E/M code must be accurate
Rita A. Scichilone, MHSA, RRA, CCS, CCS-P, health information management consultant at Professional Management Midwest in Omaha, NE, agrees. "One of the important things that hospitals have to pay attention to, especially if HCFA goes with a combination CPT and ICD-9 grouping mechanism - which is discussed in the proposal - it's important to assign the correct level for the evaluation/management code for the clinic and ED visits."
Most hospitals aren't familiar with that step, Scichilone warns. "Up until now, it's been a physician-designated responsibility," she says. HCFA will decide whether the code will be driven by hospitals, or whether they will rely on physicians to select the code. "It looks like a hybrid system, with the level-of-visit code and ICD-9 diagnosis code, is what they're leaning toward," she says.
Don't forget the business office
In the business office, make sure your staff can evaluate the data coming in for claims submission and identify items that are being billed that could pend the claim, Yoder warns.
"Monitor how timely the bill goes out the door in case any billing thresholds are announced later," she suggests.
Also, registration is important because patients need to be designated to the appropriate service department, Yoder says. For example, staff should correctly designate whether a visit is for a surgery encounter or a lab encounter, she says.
Overall, documentation is taking on a new importance, emphasizes Scichilone. "It represents such a tremendous opportunity for health information management and coding professionals to again influence the financial success of organizations they work for," she says. "Now people will start to care what CPT code is submitted for outpatient reimbursement for Medicare patients."
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