Facilities - Type of Healthcare Organization
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News and Important Information
Articles
- Identifying the Admitting, Principal, Primary, and Secondary Diag - (2023-04-25)
- Facility Outpatient E/M Coding guidance on which codes to report based on the type of service provided (03/20/2023)
- So How Do I Get Paid for This? APC, OPPS, IPPS, DRG? (2019-08-21)
- IPPS and DRG's: What it Means (2020-12-08)
LINKS
- CMS.gov Skilled Nursing Facility Billing Reference
- CMS.gov Ambulatory Surgical Centers (ASC) Center
- MLN :Update: Ambulatory Surgical Center Payment System Effective 2024
- MLN: Rural SCHs will no longer get payment reductions for HCPCS code G0463 when billed with modifier PO based on our final CY 2023 policy to exempt rural SCHs from the method to control for unnecessary increases in volume policy. Eff 01/01/2023
Learning Corner
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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
- Independent: Not part of a provider of services or any other facility
- Hospital: ASC under common ownership, licensure, or control of a hospital
Access the below ASC related information from this page.
Resources
Find-A-Code Tools Used for Facilities
Facility Location
Claims and Billing Resources
Additional Links and Resources (OIG, Claims, Newsletters...)
There are 1 sections in the Guide.
Select the title to see a summary and a link to the full article. some articles require a subscription to view.
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.
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.
Mar 20th, 2023
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.
Mar 7th, 2023
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?
Oct 31st, 2022
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.
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.
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.
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.
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?
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.
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.
Jul 7th, 2022
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.
Jun 23rd, 2022
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...
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...
Jun 9th, 2022
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...
Oct 28th, 2021
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 ...
May 25th, 2021
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 ...
Dec 8th, 2020
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 ...
Aug 21st, 2019
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 ...
Aug 19th, 2019
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.
Select the title to see a summary and a link to the full webinar information. some webinars require a subscription to view.
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.Jun 8th, 2023
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?"Mar 9th, 2023
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.Jan 12th, 2023
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.Links and resources by topic.
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