Modules Available for Advanced Coding, Billing & Reimbursement Series

Modules Available For Advanced Coding, Billing & Reimbursement Series

Modules For:

‘Advanced Coding, Billing & Reimbursement’ Series

1. Assuring Charge Master Compliance à Objective: To carefully review various Charge Master compliance issues as a part of the overall coding, billing and reimbursement process.

i. Current Update Information

ii. Charge Master Compliance Issues

a. Review Of Compliance Issues

b. Supply Categorization

c. Establishing Charges For The Charge Master

d. Charge Master To Billing System Interface

e. Provider Staff To Charge Master Interface

2. Observation Services à Objective: To provide a comprehensive review of observation services, proper coding and billing along with compliance concerns.

i. Current Update Information

ii. Observation Services – Defined

iii. Coding & Billing For Observation

iv. Documenting Observation Status

v. Care Paths For Observation

vi. Compliance Concerns

3. APC Update for CY2005à Objective: To provide a comprehensive update for 2005 update for APCs, CPT and HCPCS coding including changes that are needed for the Charge Master.

i. Current Update Information

ii. APC Update – Rules & Regulations

iii. CPT Coding Update

iv. HCPCS Coding Update

v. Charge Master Changes

vi. Billing/Claims Filing Changes

4. Optimizing APC Reimbursement à Objective: To review coding, billing and reimbursement strategies for generating proper APC reimbursement.

i. Current Update Information

ii. APC Impact Analysis

iii. Cost Outliers

iv. Transitional Pass-Through Items

v. Correct Coding

vi. Charge Master Strategies for APCs

5. ED Coding, Billing & Reimbursement à Objective: To review the coding, billing and reimbursement process for the ED for both the technical and professional components.

i. Current Update Information

ii. ED Coding, Billing & Reimbursement

a. Professional Billing & Coding

b. RBRVS & Modifier Considerations

c. Technical Billing & Coding

d. APC Impact

6. Provider Based Status Rulesà Objective: To provide a comprehensive review of the provider-based status rules along with necessary changes to meet the October 1, 2002 deadline.

i. Current Update Information

ii. Provider-Based Status

a. Review Rules & Regulations

b. Review Project Planning Process

c. Assess Hospital Readiness – Checklist

d. Update On Rule Changes

7. HIPAA for Coding, Billing & Reimbursement à Objective: To review the HIPAA Transaction Standards and Standard Data Set implementation process and its impact on coding, billing and reimbursement.

i. Current Update Information

ii. HIPAA For Coding, Billing & Reimbursement

a. Transaction Standards

b. Standard Data Sets

c. Changes To The Charge Master

d. Claims Filing Changes

e. Update On Security and Privacy

8. Assuring APC Compliance à Objective: To review a comprehensive list of compliance concerns for APCs.

i. Current Update Information

ii. Charge Master Issues

iii. Coding Compliance

iv. Billing Compliance

v. Proper Use Of Modifiers

vi. CMS’s Correct Coding Initiative

9. Establishing Provider-Based Clinics à Objective: To review the process for setting up provider-based clinics and appropriately coding and billing for clinics.

i. Current Update Information

ii. Provider-Based Clinics

iii. Freestanding Clinics

iv. Advantages Of Being Provider-Based

v. Utilization Of Non-Physician Providers

vi. “Incident-To” Rules

10. Conducting Coding, Billing & Reimbursement Audits à Objective: To provide a systematic process for conducting coding, billing and reimbursement audits including checklists of areas to review.

i. Current Update Information

ii. Conducting A CBR Audit

a. Establishing Audit Objectives

b. Probe Audits

c. Determining Sample Size

d. Process Of Sample Selection

e. Understanding The OIG’s RAT-STAT Program

f. Audit Process and Report Generation

11. ED and EMTALA Compliance à Objective: To review the EMTALA rules and their interface to the coding, billing and reimbursement process.

i. Current Update Information

ii. ED & EMTALA

a. Basic EMTALA Requirements

b. EMTALA Interface To Coding/Billing

c. Provider-Based Interface

d. EMTALA Outside The ED

12. DME – Coding, Billing & Reimbursement à Objective: To review the proper way to code, bill and set up the Charge Master for Durable Medical Equipment and related items.

i. Current Update Information

ii. DME – What Is It?

iii. DMERCs – What Is Covered?

iv. The CMS Form 855S

v. Hospital Billing Of DME

vi. Physician/Clinic Billing Of DME

13. Coding & Billing for Non-Physician Providers (NPPs) à Objective: A comprehensive review of all types of NPPs (e.g., PAs, NPs, CNSs, RTs, CENTs, RTs, CRNAs, etc.), the way in which they can be utilized and proper billing techniques for both hospital and freestanding clinics.

i. Types of NPPs

ii. “Incident-To” Services

iii. PINs and Form 855s

iv. Technical Component Billing

v. Professional Component Billing

14. Effective Modifier Utilization à Objective: To review the proper use and utilization of modifiers for hospital, technical component billing.

i. Types of Modifiers – Payment vs. Non-Payment

ii. CMS’s Correct Coding Initiative

iii. “-59” Modifier Utilization – Examples

iv. “-25” Modifier Utilization – Examples

v. Other Modifiers

vi. Documentation and Compliance Issues

15. Interventional Radiology, Cath Lab à Objective: To review coding and billing for surgical interventional radiology, catheterization laboratory and vascular laboratory in connection with APCs.

i. Component Coding Concept

ii. Charge Master Charge Explosion Process

iii. Surgical To Radiology Code Correlation

iv. Cath Lab Coding and Billing

v. Peripheral Vascular Lab Coding and Billing

16. Blood/Blood Bank Coding & Billing à Objective: To review the coding and billing for blood, blood products and blood bank activities with particular attention to the APC payment system.

i. Component Approach

ii. Review of Blood Product Codes/Payments

iii. Medicare Rules & Regulations

iv. Proper Revenue Center Code to CPT/HCPCS

v. Blood Bank Activities

vi. Coding/Billing Compliance Concerns

17. Non-Medicare Coding, Billing & Reimbursement à Objective: To review the difference in the coding, billing and reimbursement process for non-Medicare third-party payers and the differences in billing and claims submissions.

i. Managed Care Contracting

ii. Different Payment System Concepts

iii. Different Claims Format Requirements

iv. Conflicts between Medicare Requirements and Non-Medicare Requirements

v. Necessary Charge Master Adjustments

vi. Compliance Concerns

18. Radiation Oncology, Brachytherapy and Nuclear Medicine à Objective: To review the proper coding and billing requirements for these special areas, including proper billing for various expensive supply items.

i. Radiation Oncology Treatment Planning Coding/Billing

ii. Radiation Treatment Delivery and Management

iii. Brachytherapy

iv. Expensive Supply Items

v. Nuclear Medicine

19. ABNs: Effective Utilization and Compliance à Objective: To review the ABN forms, proper use of ABNs, and the compliance issues raised in their use.

i. Advance Beneficiary Notices (ABNs) – What are they?

ii. Relationship to NONCs (Notices of Non-Coverage)

iii. Service Areas In Which ABNs Should Be Used

iv. Compliance Issues Surrounding Use Of ABNs

v. Proper Use of ABNs

20. Conducting Charge Capture Studies à Objective: To review the process of conducting charge capture studies through a systematic process of analyzing service and documentation flow for given service areas.

i. Charge Capture, Charge Entry Process

ii. Identifying Service Area Procedures & Processes

iii. Charge Master Interface

iv. Encounter Forms, Charge Sheets, Order Entry

v. The Billable and Codeable Concept

vi. Payment System Variances

21. Hospital Compliance Update à Objective: To review the current status of OIG compliance issues in connection with hospital services and associated payment systems.

i. Review the FY2005 OIG Work Plan

ii. Inpatient Issues and Necessary Audits

iii. Outpatient Issues and Necessary Audits

iv. Physician Issues and Necessary Audits

v. Other Payment Related Compliance Concerns

vi. HIPAA Compliance and Status

vii. Tax, Environmental and Organizational Issues

22. Interventional Radiology Coding, Billing & Reimbursement: Surgical and Coronary Catheterization Laboratory à

a. Objective: To review and discuss the coding, billing and development of correct claims for surgical interventional radiology and the procedures in the coronary catheterization laboratory both diagnostic and therapeutic. Coding and billing idiosyncrasies will be reviewed along with the charge master interface.

b. Brief Outline:

i. Component Coding/Billing Approach

ii. Surgical Case Studies

iii. Coronary Catheterization Laboratory Case Studies

iv. Charge Master Set Up and Coding Interface

v. Charge Master Set Up and Charge Capture

vi. Special Supply Considerations

vii. Documentation Systems and Correlation With Coding/Billing

viii. Auditing Claims for Correctness

ix. Case Studies – Coding and Billing

23. Interventional Cardiovascular Coding and Billing à

a. Objective: To discuss and review the complexities of coding and billing in the vascular (non-coronary catheterization) area. The charge master set up, coding and billing idiosyncrasies, the CCI edits and compliance concerns will all be addressed.

b. Brief Outline:

i. Component Coding for the Vascular Laboratory

ii. Catheter Placement Coding/Billing

iii. Radiological Coding/Billing

iv. Modifier Utilization

v. Establishing the Charge Master

vi. Charge Capture Concerns

vii. Special Supply Considerations

viii. Therapeutic Interventions

ix. Drug-Eluting Stents

x. Case Studies – Coding and Billing

24. Stents, Drug-Eluting Stents and Transcatheter Stent Placement à

a. Objective: To review the coding, billing and charge master setup for coronary and non-coronary stent placements including a discussion of Medicare’s approach to drug eluting stents.

b. Brief Outline:

i. Review Stents and Drug Eluting Stents

ii. Coding/Billing – Intracoronary Stents – Examples

iii. Coding/Billing – Non-Coronary Stents – Examples

iv. APC Approach To Drug Eluting Stents

v. DRG Approach To Drug Eluting Stents

vi. Reimbursement Difficulties for Stent Placements

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