Condition Codes W2 and 44: Strategies for Reimbursement for Non-Covered Inpatient Stays - On-Demand
Thursday, February 23, 2017
Kimberly Anderwood Hoy Baker, JD, CPC
Level of Program:
Condition codes W2 and 44 both allow hospitals to recover some reimbursement for incorrect inpatient orders; however, they require different processes and, depending on the situation, may generate slightly different payments. Hospitals should consider shifting to condition code W2, rather than condition code 44, through a self-denial process. This webinar will discuss strategies to take advantage of efficiencies in the utilization review (UR) process through the use of condition code W2 while minimizing negative impacts on the revenue cycle.
Join expert speaker Kimberly Anderwood Hoy Baker, JD, CPC, as she discusses operational strategies for using condition code 44 and W2 processes to get reimbursement for inpatient non-covered cases while leveraging UR resources. She will offer tips for concurrent and post-discharge review, including the interface between UR and coding and billing. She will also break down case studies to compare payment using condition codes 44 and W2.
At the conclusion of this program, you will be able to:
- Explain two differences between billing mechanisms for condition codes 44 and W2
- Identify the three requirements for use of condition code W2
- Name the three entities that must receive notice after a self-denial by the UR committee
- Articulate the differences in patient financial liability for inpatient Part A, inpatient Part B, and outpatient Part B
Who Should Listen?
- Coding managers and staff
- HIM managers
- Compliance staff
- Utilization review staff
- Chargemaster coordinators
- Billing managers and staff
- Case management
- Discussion of strategies and rationale for using condition code W2 rather than condition code 44
- The financial impact of using condition code W2 vs. condition code 44 from the patient’s and the hospital’s perspective
- Processes for moving away from condition code 44 and operationalizing condition code W2
- Case studies to illustrate the impact of condition codes W2 and 44 on the patient and facility
- CoP compliant UR determination form
- Patient UR determination letter
- Procedure for UR determination for non-covered inpatient cases
(Live + On Demand) -This program has the prior approval of AAPC for 1.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. (Ability to claim CEH’s for this webinar expires on: 2/22/2018)
(Live + On Demand) - 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). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor. (Ability to claim CEU’s for this webinar expires on: 02/22/2018)
(Live + On Demand) This program has been pre-approved by The Commission for Case Manager Certification to provide continuing education credit to CCM® board certified case managers. The course is approved for 1.5 CE contact hour(s). (Ability to claim continuing education credits for this webinar expires on: 2/22/2017)
Meet the Speaker
Kimberly Anderwood Hoy Baker, JD, CPC, is the director of Medicare and compliance for HCPro. She is a lead regulatory specialist and lead instructor for HCPro's Medicare Boot Camp®—Hospital Version and Medicare Boot Camp®—Utilization Review Version. She is also an instructor for HCPro’s Medicare Boot Camp®—Critical Access Hospital Version. She is a former hospital compliance officer and in-house legal counsel, and has 10 years of experience teaching, speaking, and writing about Medicare coverage, payment and coding regulations, and requirements.
Webinar system requirements and program materials:
To fully benefit from the webinar experience, please note you will need a computer equipped with the following:
Internet: 56K or faster Internet connection (high-speed connection recommended)
Streaming: for audio/video streaming, Adobe Flash plug-in or Safari browser on iOS devices
Prior to the webinar, you will receive an email with detailed system requirements, your login information, presentation slides, and other materials that you can print and distribute to all attendees at your location.
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Participation in the webinar is just $259 per site. All materials must be retrieved from the Internet.
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