Facilities - Type of Healthcare Organization

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An ASC is defined as an entity that operates exclusively for furnishing outpatient surgical services to patients. To receive coverage of and payment for its services under this provision, a facility must be certified as meeting the requirements for an ASC and enter into a written agreement with CMS.

Two Types of ASCs

  1. Independent: Not part of a provider of services or any other facility
  2. Hospital: ASC under common ownership, licensure, or control of a hospital

Access the below ASC related information from this page.

 

 

 
 

Resources

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Computer-Assisted Medical Coding (CAC) vs Autonomous Medical Coding to Strike the Perfect Balance Between Automation and Human Coder Expertise

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Healthcare is witnessing a digital revolution of sorts with advancements in technology that seem to transform many aspects of patient care. An example of this transformation involves the evolution of medical coding, where computer-assisted medical coding (CAC) and the use of artificial intelligence (AI) in medical coding are revolutionizing the way healthcare organizations document, process, and ensure medical necessity for healthcare services.

Identifying the Admitting, Principal, Primary, and Secondary Diagnoses

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

If you have ever had a difficult time differentiating between the admitting diagnosis, principal diagnosis, and primary diagnosis then look no further. Each of these diagnoses play an important role in reporting services and ensuring correct coding and sequencing has occurred. Let's take a closer look at each of these diagnosis types and when they are reported.

Facility Outpatient E/M Coding

by  Wyn Staheli, Director of Content - innoviHealth

Reporting outpatient E/M services in a facility setting is a little different than other outpatient services. It is important to follow payer guidance. Novitas has provided some guidance on which codes to report based on the type of service provided. They have an FAQ which covers both emergency department (99281-99285, G0380-G0384) and clinic visits.

Keeping up on Split or Shared Service Changes

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

With the 2023 CPT Evaluation and Management (E/M) changes to facility services, policy and guideline updates have been made for documenting and reporting split or shared visits. Interestingly, CPT has also updated their Evaluation and Management (E/M) service guidelines to recognize and define "shared or split services," leaving us to wonder where this new term will eventually take us. Is this the AMA's attempt to collaborate more with Medicare or possibly a preview of CPT and Medicare's future alignment on issues like this?

CMS Updates COVID Vaccine Requirements for Staff

by  Wyn Staheli, Director of Content - innoviHealth

CMS is revising its guidance and survey procedures for all provider types related to assessing and maintaining compliance with the staff vaccination regulatory requirements. This new memorandum replaces memoranda QSO 22-07-ALL Revised, QSO 22-09-ALL Revised, and QSO 22-11-ALL Revised.

Four Ways Your Organization Can Benefit from Gathering and Reporting Social Determinants of Health Data

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Providers who actively engage in collecting and reporting social determinants of health (SDoH) open avenues of identifying and treating their patients' population health trends. Pairing chronic conditions that are difficult to control with identified SDoH circumstances such as transportation or electricity insecurity, can help identify those patients who may wish to be healthier, but who are dealing with circumstances that prevent compliance, such as transportation or access to electricity, for instance.

Is the Patient Truly Ill? Why Random Audits Could Prevent Recoupment

by  Ronald Hirsch, MD FACP CHCQM CHRI

Three items are discussed in this article: First, performing random audits of critical care visits billed with CPT codes 99291 and 99292 to ensure the patient was truly critically ill, which could help avoid recoupment. Secondly, time will tell if rural hospitals will switch to the rural emergency hospital designation. Lastly, a 2023 OPPS proposed rule, CMS discusses creating a new payment category, paying for software as a service.

Seven Major Changes Proposed by CMS in the 2023 Proposed Rule

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

As the COVID-19-related public health emergency (PHE) seems to be dying down, CMS publishes the 2023 Medicare Proposed Rule that outlines more than a dozen major changes to existing programs, including some that relate to telemedicine after the PHE is declared officially over. Of the many changes, seven (7) really stand out and make us think about how the end of the PHE may affect services such as telemedicine or new E/M encounter types.

CMS Encourages Medicaid MCOs and CHIP to Employ Section Waivers to Improve SDoH and Reduce Healthcare Costs

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Over the past few years, at least 15 states have consistently pursued the goal of using social determinants of health (SDOH) in their overall healthcare analysis and treatment programs for patients, and CMS has taken notice. Data and outcomes obtained from these state programs have essentially provided an outline of how the government intends to pursue health equity through managed care contracts (MCOs) and Children's Health Insurance Program (CHIP). What is CMS seeing that they like so much and how might that affect future MCO contracts?

How CMS Determines Which Telehealth Services are Risk Adjustable

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.

The Beginning of the End of COVID-19-Related Emergency Blanket Waivers

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

It appears that the end of the 1135 waivers related to the COVID-19 public health emergency (PHE) has begun. According to CMS, the residents of skilled nursing facilities, long-term care facilities, and inpatient hospice centers have struggled due to the effects of some of the 1135 waivers. CMS is focusing primarily on removing the 1135 blanket waivers that pertain to certain aspects of care, training, and maintenance of these facilities to ensure the weakest of our citizens are guaranteed adequate care.

New Audio-Only Telehealth Guidance to Meet HIPAA Rules

by  U.S. Department of Health & Human Services

Covered entities (healthcare providers and health plans) can use remote communications, called telehealth, to provide services to patients as long as they follow certain guidelines. Because certain populations may have difficulty using audio-video telehealth, HHS is now issuing this guidance on audio-only telehealth. This guidance will help ensure that individuals can continue to benefit from audio-only telehealth by clarifying how covered entities can provide telehealth services and improve public confidence that covered entities are protecting the privacy and security of patients' health information.

Why You Should Be Using The Two-Midnight Rule

by  David M. Glaser, JD

Are you using something other than two-midnight? Here’s why you shouldn’t be. Is there the possibility that your utilization management team and physician advisors are applying InterQual, MCG, or any other utilization tool other than the two-midnight rule to your Medicare admissions? Over the last few months, it has...

Using Health IT to Support Safer Use and Management of Controlled Substance Prescriptions

by  Chelsea Richwine  and  Christian Johnson

New ONC data show that, as of 2021, nearly all non-federal acute care hospitals were enabled to electronically prescribe controlled substances (EPCS). According to the American Hospital Association (AHA) Information Technology (IT) Supplement Survey, the proportion of non-federal acute care hospitals enabled for EPCS increased from 67% in...

The Nuances of the Two-Midnight Rule

by  David M. Glaser, JD

When is a patient an inpatient? A reader we’ll call Michelle asked a question during a recent Monitor Mondays broadcast — a question that encapsulated many of them: how can a Medicare patient who stays two midnights for a non-medical reason be an inpatient?  For example, consider a...

Understanding ASCs and APCs: Indicators and Place of Service

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

The decision regarding the most appropriate care setting for a given surgical procedure is determined by the physician based on the patient's individual clinical needs and preferences. Of course, there is a difference in reimbursement, and the billing depends on where the procedure took place, such as an office setting, inpatient ...

PCS Coding for Ankle Fracture - Look Deeper Into the Codes!

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

If you're looking for ankle fractures in ICD-10-PCS, you may need to look a little deeper. Let's take a look at coding an ankle fracture such as a trimalleolar fracture. PCS coding can be confusing as it is nothing like CPT coding; with CPT we can simply code an ankle ...

IPPS and DRG's: What it Means

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Understanding hospital pricing can get complicated, so we have broken it down according to CMS and the acute Inpatient Prospective Payment System, also known as IPPS. Find-A-Code uses IPPS for inpatient pricing with our MS-DRG grouper. The following information comes from CMS.gov and answers the most common questions regarding DRGs ...

So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from?  It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems.  One of the ...

Understanding Payment Indicators

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Understanding how payment works with Medicare payment indicators and the impact a modifier has on payment is vital to pricing. Even if you are not billing Medicare, most carriers follow Medicare's policies for participating and non-participating rules.  Here is an article from Regence on their policy statement, describing the rules ...

There are 6 related documentation, coding and billing tips.

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Select the title to see a summary and a link to the full webinar information.  some webinars require a subscription to view.

Documentation Best Practices for Emergency Department Services 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Emergency Department E/M services were significantly revised beginning in 2023. Key components as we knew them are gone and observation services were also changed. Join us for this informative webinar to learn what needs to be done to ensure that your documentation and coding practices are current and compliant.

Looking Closer at High Risk EM Medical Decision Making 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Thursday @ 10:15 AM PST, 11:15 AM MST, 12:15 PM CST, 1:15 PM EST Join us for a deep dive into the Evaluation & Management element of "Risk". Learn more about the differences between complications, morbidity, and mortality and how that drives coding. What does it really take for an encounter to be considered "High risk?"

Keeping up to date on reporting changes... 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Properly reporting split or shared patient encounters can be tricky. The CPT codebook just began defining this type of encounter and the 2023 Medicare Physician Fee Schedule Final Rule included some changes. Tune into this informative webinar to ensure that you are doing things the right way.

Current Terminology - 2023 Annual Update Summary

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Be sure you are ready for 2023 with this review of the upcoming coding and reimbursement updates for 2023. This informative webinar discusses changes to CPT codes and guidelines including a summary of the changes to E/M services and an overview of changes to other CPT categories.

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