Revenue Spotlights

We live in a healthcare environment that has gone mad with prospective payment systems (PPS). Inpatient PPS, outpatient PPS, rehab PPS, and other similar systems mean that there is a greater demand for coders in healthcare today than ever. And the timing could not be worse — perhaps you've heard that there is a nationwide coder shortage. Maybe you're even experiencing this phenomenon firsthand with open coding positions and difficulty in filling them. So where have all the coders gone? And where can we find more of them? Read this month's RMD Spotlight for more information

Now that we have had six months to become familiar with the OPPS CY2008 guidance from CMS on coding hydration, injections and infusions, this is a good time to review some important points. Click here to review.

CMS proposes to add 43 new quality measures to the current 30 measures hospitals must report in order to receive their full annual update to Medicare inpatient payment ratess. Click here to learn more.

The Centers for Medicare & Medicaid Services (CMS) encourages hospitals to “schedule patients in such a way that they can use drugs or biologicals most efficiently, in a clinically appropriate manner.” However, if the remainder of a single use vial or single use package must be discarded after a drug/biological has been administered to a Medicare patient, Medicare will pay for the wasted amount along with the amount administered, up to the amount of the drug or biological as indicated on the vial or package label. April's RMD Spotlight provides more information.

Over the past few years CMS has implemented several strategies to capture the cost of expensive devices that are used in conjunction with certain outpatient procedures. The latest version of this process is captured in the Medicare Claims Processing Manual 100-04, Chapter 4, section 61, and in MedLearn Matters article MM4017. Read July's IRM Spotlight to learn more!

June 2006 UPDATE: The Office of the Inspector General (OIG) continues to watch cardiac rehabilitation services closely. Review this IRM Spotlight to learn more about Outpatient Cardiac Rehab and the tools and best practices for reimbursement and compliance.

CMS recently added two additional diagnoses that meet criteria for the implantation of AICDS and they are 996.04 and V53.32. CMS has backdated the use of those codes and will allow denied claims with those diagnosis codes to be re-billed. Read this month's RMD Spotlight for more info.

The Office of the Inspector General (OIG) continues to watch cardiac rehabilitation services closely. Review this IRM Spotlight to learn more about Outpatient Cardiac Rehab and the tools and best practices for reimbursement and compliance.

According to the most recent five years of Medicare Provider Analysis and review data, between 45 percent of all Inpatient hospital admissions are being processed without a primary ICD-9 procedure code. Read this month's RMD Spotlight for more information.

The potential for increased reimbursement by auditing Home Health Medicare PPS (Prospective Payment System) episodes with a negative response to the MO825 Oasis (Outcome & Assessment Information Set) question. Read this month's RMD Spotlight for more information.

The potential impact of 2006 DRG changes on coding as well as managed care contracts and payments. Read this month's RMD Spotlight for more information!

Billing CMS for replacement of cardiac pacemakers and defibrillators that have been recalled by the manufacturer. Read this month's RMD Spotlight for more information!