Charging Bedside Procedures beyond the Room Rate
Product Description:
Audio Conference on CD or Audio On-Demand
Sponsored by Briefings on APCs
A program for finance directors and revenue cycle administration
presented on July 16, 2009
PROBLEM
Hospitals frequently assume that their room rates are intended to include all nursing unit services into one rate. Hospitals rarely perform analyses to explicitly define what is included in the room rate. CMS states "[services] not specifically mentioned in the definition of routine services in PRM-1 under Section 2202.6" are appropriate for separate charges. Therefore, facilities are missing a potential revenue opportunity. CMS allows facilities to line-item report what are traditionally thought of as outpatient nursing services-such as injections, infusions, transfusions, Foley catheter insertions, and more-on inpatient claims. Hospitals are often uncomfortable with this process because they are concerned they will be "double-dipping," and they do not know how to establish internal policies and procedures to ensure the billing is done correctly.
SOLUTION
Once hospital administrators understand they can bill for bedside procedures separately and that it can be done in a compliant manner, they can make an informed decision on whether it is appropriate for their facility.
LEARN FROM US
HCPro presents the 120-minute audio conference featuring Jugna Shah, MPH, Valerie A. Rinkle, MPA, and Denise Williams, RN, CPC-H. They use real-life examples to illustrate how facilities can break out non-routine services and procedures by line item in compliance with CMS standards. You will learn how to achieve buy-in from hospital leadership and how to justify line-item charges with your non-Medicare payers.
NOTE:
You will benefit most from the program if, prior to the program, you review both the excerpt from the 2009 IPPS final rule and links to the Provider Reimbursement Manual definitions of routine services vs. ancillary nursing services that will be provided as part of the materials packet.
LEARNING OBJECTIVES
At the conclusion of this audio conference, you will be able to:
- Explain how facilities are allowed to charge for bedside procedures for inpatients—which types and the appropriate backup/citations to reference
- Demonstrate how to implement charging this way at your facility, including how to mobilize staff, the revenue codes to use, and the link between line items on a claim and the effect on cost reporting
- Describe the effect on government payers vs. non-government payers and the opportunity for increased revenue
AGENDA:
- Regulatory justification supporting classifications
- Busting the myth: Charging separately for bedside procedures on inpatients
- CMS interpretation
- CMS guidance from regulations (IPPS and OPPS), transmittals, RTI report
- Implications on rate-setting, compliance and revenue
- Survey findings
- How charging for inpatient bedside procedures isn't considered double-dipping
- Inpatient vs. outpatient
- Physician charges vs. nursing resources
- Types of services and clinical synopses
- Injections
- Infusions
- Transfusions
- Lumbar puncture
- Foley catheter insertions
- Legitimate strategies for charging bedside service on your inpatients
- Who needs to be involved?
- Reviewing your existing room/board rate
- Determining what revenue codes to use
- The effect on cost reporting
- How will charge capture occur?
- How to treat non-Medicare payers
- Summary
- Estimated bottom-line impact from non-Medicare payers
- What you charge impacts future Medicare MS-DRG payments
- Non-Medicare payers, existing contracts, etc.
- Internal systems, staff support, leadership recognition
- Question and answer session
CONTINUING EDUCATION
This program has prior approval of the American Academy of Professional Coders for 1.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the Academy of the program, content or the program sponsor. Credits expire on June 30, 2010.
MEET THE SPEAKERS
Jugna Shah, MPH, is president of Nimitt Consulting in Washington, DC. She has extensive experience helping providers understand and manage the clinical, operational, and financial changes associated with Medicare's OPPS/APC payment system, facilitating APC task force meetings, strategic planning sessions, financial impact analyses discussions, and managing APC implementation and assessment projects. She works extensively on drug administration coding and billing matters with providers, conducts compliance and revenue recovery audits, and provides comments and system improvement suggestions to Medicare's APC Advisory Panel.
Valerie A. Rinkle, MPA, is revenue integrity director for Asante Health System in Medford, OR. She has more than 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 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.
Denise Williams, RN, CPC-H, is director of revenue integrity services for Health Revenue Assurance Associates, in Plantation, FL. She has more than 20 years of healthcare experience, including as a clinical nurse, in compliance for a multi-hospital system, and as chargemaster coordinator for multi-hospital systems. She has presented educational sessions both within the hospital systems and nationally via webinars for HRAA, and recently published an article on the 2009 OPPS changes in AAPC's Coding Edge. She is a member of the HCPro editorial advisory board for the APC Weekly Monitor.
WHO SHOULD LISTEN?
Professionals employed by acute care hospitals—specifically those who address inpatient charge capture—including finance manager/staff, cost reporting, revenue cycle management, compliance officer/staff, chargemaster coordinators, and nurse auditors/internal auditors.
Audio On-Demand
In addition to the regular purchase options for HCPro audio conferences, we are pleased to offer an audio on-demand, which allows you to download the program and play it back at your convenience through your computer or MP3 player. Purchase an audio on-demand 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.Product Types : Departments :
