Inpatient-only Procedures
Know the Rules, Understand the Exceptions, and Avoid Lost Revenue
Product Description:
AUDIO CONFERENCE ON CD OR ON-DEMAND
Sponsored by Medicare Boot Camp® - Hospital Version
Presented on August 17, 2011
CMS has specific rules about paying for inpatient-only procedures that are provided in an outpatient setting. Unless the case falls into one of a few exceptions, you’ll lose valuable reimbursement.
During this 90-minute audio conference, our speakers cover the inpatient-only concept and applicable regulations/guidance. They show you where to find the inpatient-only procedure list and how to establish a process for flagging inpatient-only procedures. They also discuss how to bill for special inpatient-only situations. They use a case study to demonstrate best practices for compliance with the rules.
Note: This is an intermediate-level program. Listeners should have an understanding of basic billing concepts.
LEARNING OBJECTIVES
At the conclusion of this audio conference, you will be able to:
- Locate and review the regulations and billing rules regarding inpatient-only procedures
- Describe special inpatient-only scenarios and identify the potential effect on reimbursement
- Identify risk areas related to reimbursement of inpatient-only procedures
- Develop policies and procedures to identify and correctly schedule inpatient-only procedures and ensure a valid inpatient order is written
- Employ educational strategies to train surgeons/office staff, OR schedulers, registration staff, and case management on inpatient-only procedures and their roles in ensuring appropriate reimbursement
THE AGENDA
- CMS regulations for inpatient-only procedures
- Federal Register definitions of inpatient-only procedures
- Medicare Claims Processing Manual billing rules
- OPPS Addendum B list of inpatient-only procedures
- Payment implications and exceptions for performing inpatient-only procedures on an outpatient basis
- No reimbursement
- Emergency exception
- Separate procedure exception
- Other considerations
- CMS’ guidance for admitting patient following outpatient surgery
- Three-day payment window considerations
- Patient’s and hospital’s financial responsibilities
- Policies, procedures, and best practices
- Scheduling
- Pre-registration
- Pre-op holding
- Post-op
- Education: Case study
- Surgeons and office staff
- OR schedulers
- Registration staff
- Case management staff
- A question and answer session follows the presentation.
MEET THE SPEAKERS
Debbie Mackaman, RHIA, CHCO, is an instructor for HCPro’s Medicare Boot Camp®-Hospital Version and the Medicare Boot Camp®-Critical Access Hospital Version. She is a former hospital compliance officer and HIM director and has more than 20 years of experience in the healthcare industry, including both inpatient and outpatient Prospective Payment Systems (IPPS, OPPS) and Critical Access Hospital (CAH) chargemaster, coding, billing and reimbursement issues.
Sandra McCune BSN, RN, is a utilization management specialist at Lakeland Regional Health System in St Joseph, MI. She is responsible for assuring compliance with Medicare and Medicaid regulations regarding billing status, medical necessity, readmission bundling, and IM Letters. She has more than 30 years healthcare experience, including 15 years of bedside nursing, five years in utilization review, and 14 years in care management.
CONTINUING EDUCATION
AAPC: 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.
AHIMA: This program has been approved for 1.0 continuing education unit for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).
WHO SHOULD LISTEN?
Patient financial service, HIM, and registration managers and staff; compliance auditors/officers; coders/billers; case managers; physician advisors; surgery managers
BONUS MATERIAL INCLUDED IN YOUR MATERIAL PACKET
In addition to the expertise and advice presented during this audio conference, you'll receive a slide presentation of the program materials and valuable takeaways, which you can use at your facility, including:
- Sample policy and procedure
- Sample OR scheduling/status order form
- Sample education materials surgeons and office staff
- Sample education materials for hospital staff
- Article from Medicare Weekly Update about three-day rule
AUDIO ON-DEMAND
In addition to the regular participation options for HC Pro audio conferences—live, CD, or combination packages—we are pleased to offer another option, audio on-demand. Audio on-demand allows you to download the program and play it back at your convenience through your computer or MP3 player. It's also a perfect training tool for new staff or as a refresher for veteran staff.
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