Getting bill to customers means swimming through an ocean of legislation
Getting bill to customers means swimming through an ocean of legislation
But there are plenty of minor problems to deal with
The early stages of the outpatient prospective payment system (PPS) implementation have not been overwhelmed with payment problems or major software glitches. But the system still is providing plenty of challenges as providers struggle with coding issues and do their best to keep their heads above water in an ocean of complicated legislation.
"The major problem with the outpatient PPS is the sheer complexity of the system. People are having large internal backlogs created just because of the difficulty in getting the bill out," says Deborah Williams, senior associate director of policy development for the American Hospital Association (AHA) in Washington, DC.
Making a modification
Part of the problem with the system is confusion about the use of modifiers, she says. "At the last minute, HCFA [Health Care and Financing Administration] changed a lot of the use of the modifiers and required retraining. HCFA is also having a lot of problems implementing the modifiers. If you look at its Web site, you will see that many of the errors reported are those related to modifiers."
The jury is still out on whether providers are receiving proper reimbursement from claims submitted under outpatient PPS. The system was implemented Aug. 1, but HCFA held onto claims for two weeks afterward. Many hospitals decided not to submit their claims until after Aug. 14 fearing that system glitches or their unfamiliarity with the program might cause errors in their filings, according to AHA sources.
Providers are also struggling to reconcile what they knew about compliance and billing and what they must now do to receive reimbursement.
"That leaves us literally between a rock and a hard place," says Laura Frazier, RHIT, manager of APC Solutions for QuadraMed Corp., of San Rafael, CA, a health care information systems company. "We don’t want to work for free. We need to get reimbursed for the services we provide. But to do that, we have to ignore compliance and billing instructions in some instances."
Track every remittance
HCFA has experienced a few software glitches, so providers should check their reimbursement for errors, Frazier says. Providers, however, are finding they should refer to a hard copy of the remittance even though it presents its own unique set of problems.
"Most people work off a hard copy of the report that is filtered through staff in a department. They work in a certain alphabetic range," she explains. "But the hard copy does not correlate the APC [ambulatory payment classification] number that got paid, and the reimbursement amount is not as easy to track as it should be.
"Most people are blown away that they are going to have to track every single remittance advice to make sure that the fiscal intermediary [FI] or the FI software has not made a calculation error," Frazier adds.
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