tci Medicare Compliance & Reimbursement - 2003 Issue 21

Hospitals: GETTING IT RIGHT ON OPPS MULTIPLE-PROCEDURE CLAIMS

A hospital's misunderstanding of outpatient prospective payment system billing rules has caught the attention of the HHS Office of Inspector General. As Mercy Hospital was transitioning to OPPS, it mistakenly believed that only one surgical procedure could be claimed each time an operating room was used. As a result, when multiple procedures were performed during a single OR session, the hospital claimed ambulatory payment classification reimbursement for just one of the procedures. That meant that Mercy received far less than it deserved in APC payments - but too much in subsequent outlier payments, the OIG maintains in "Review of...

To read the full article, sign in and subscribe to tci Medicare Compliance & Reimbursement.


Keep pace with evolving Medicare regulations — and onboard your team — with timely analysis of critical updates interpreted in an easy-to-follow, easy-to-apply format. Your subscription to TCI's Medicare Compliance & Reimbursement Alert will equip you to navigate code and guideline changes, CCI edits, and revisions to modifiers, payer policies, the fee schedule, OIG target areas, and more.

  • Current newsletters added each month
  • Fully searchable archives - over 4200 articles
  • ALL years/issues back to 2003 organized by year and issue
  • Codes mentioned in articles are linked to Code Information pages
  • Code Information pages link back to related articles
Access to this feature is available in the following products:
  • tci Medicare Compliance & Reimbursement +Archives

demo
request yours today
 subscribe
start today
 newsletter
free subscription

Thank you for choosing Find-A-Code, please Sign In to remove ads.