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AUDIOCONFERENCE ON TAPE OR CD

sponsored by Briefings on APCs

presented on April 10, 2007

An observation patient stays past midnight and receives a variety of services over two dates of service, including an IV infusion. What can the hospital bill and how should these be charged on the UB-04? The answer to this question and more can be found by listening to OPPS Observation: Solutions to Difficult Coding, Charging, and Billing Scenarios.

CMS made wholesale changes to how providers code and bill observation in 2006. Although simplified, there is still a great deal of confusion with scenarios such as billing observation patients after midnight, how to code and bill observation patients who are admitted to inpatient status, and more. If you’re like most providers, you may also be missing certain separately billable procedures and other bedside procedures.

Clarification and a further understanding of the current CMS guidelines

Our expert speakers understand how hard it is to code and bill observation claims. They will offer you examples of difficult observation cases with best practices for the future. You’ll also walk away with time-saving tools and “take home” items that will reduce your chance of inappropriate payments and Office of Inspector General (OIG) investigation. Don’t let this convenient, 90-minute audioconference occur without you. The OIG has observation on its work plan in the coming year and there is no time like the present to improve your processes. Purchase today!

*Note: Participants should have a basic understanding of the utilization review practices surrounding observation and the observation policy.

PROGRAM AGENDA

1. Classifications of OPPS observation coding/billing
1. Review of Medicare guidelines
2. Use of G0378 and G0379
3. Medicare vs. private payer considerations
2. Problematic observation billing scenarios
1. Reporting bedside procedures for observation patients—with case scenarios
2. Problematic billing encounters
   1. observation hours and the first date of service
   2. overnight and 48 hours:  claim examples with units
   3. Billing observation versus extended recovery time
3. Prior OIG observation findings and 2007 OIG work plan focus on dialysis
3. Proper reporting guidelines
1. Reporting observation separate from paid OPPS observation claims
2. Direct admissions
3. Diagnosis reporting
4. Observation and drug administration
5. Other bedside procedures beyond drug administration
6. Documentation requirements
4. Inpatient-only procedures and condition code 44 with the coordination between case management and PSS
5. HIM partnerships:  Best practices for successful observation and compliance
6. Future of observation and potential changes, including possible new separately payable diagnoses inclusions
1. Common problems and corrective measures
7. Q&A

LEARNING OBJECTIVES

At the end of the audioconference, you will be able to:

1. Explain the components of observation and the codes and payment opportunities under OPPS
2. Identify which bedside nursing services you can and cannot separately report
3. Discuss inpatient-only procedures and condition code 44
4. Demonstrate how to report drug administration services for observation patients
5. Select best practice ideas and action items for successful observation and compliance, including how to bill hourly services that are not observation

FEATURED SPEAKERS

Gloryanne Bryant, BS, RHIA, CCS, is the corporate director of coding HIM compliance for Catholic Healthcare West in San Francisco, where she is responsible for coding and documentation compliance of 40 acute care facilities and a variety of other non-hospital based entities. She provides education to coders, physicians, and other hospital staff and is a member of the editorial advisory board for HCPro’s newsletter, Briefings on Coding Compliance Strategies. With more than 28 years of experience in the health information management profession, she provided testimony in support of ICD-10 implementation for the House Ways and Means Committee in April 2006.

Valerie A. Rinkle, MPA, is revenue cycle director for Asante Health System in Medford, OR. She has over 20 years of healthcare reimbursement experience including 11 years in nationwide consulting to hospitals and physicians regarding Medicare and Medicaid payment systems and compliance. She is a the author of numerous articles on OPPS and hospital-based clinics, and a member of the editorial advisory board for the APC Answer Letter and the APC Weekly Monitor, both from HCPro.

BONUS TOOLS

In addition to the expertise and advice presented during this audioconference, you'll also receive these free bonus tools:

• Sample bedside procedure charge form
• Frequently asked observation questions
• Article from HCPro’s Case Management Monthly, “Observation Status: Determining the Correct Levels,” which includes a sample observation determination flowchart poster

WHO SHOULD LISTEN?

HIM directors and managers; coding managers and specialists; compliance auditors; finance, billing, and patient account managers; reimbursement managers and specialists; chargemaster coordinators; utilization review managers; case managers; emergency department/hospital clinic staff; observation unit staff

Purchase a tape or CD of the program and listen when you can. It's also a perfect training tool for new staff or as a refresher for veteran staff.

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