tci ED Coding & Reimbursement Alert - 2012 Issue 4

Facility Documentation Guidelines: Know the Rules for Mapping Professional and Facility Code Levels

Does your current mapping methodology contain the 11 elements CMS requires?CMS has no official methodology for determining ED facility levels, but if you know where to look, there are some guidelines available for crafting your own. Read on to learn the source of CMS' guidance and tips on how to apply it to your practice.Basics: There are two components to consider when reviewing ED cases for reimbursement; the professional component for physician services and the facility component for other services, including nursing and ancillary services. The CMS Outpatient Prospective Payment System (OPPS) gives hospitals direction for reporting...

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