Inpatient-Only Procedures Training Handbook

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Inpatient-Only Procedures Training Handbook (Pack of 5)

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Inpatient-Only Procedures Training Handbook

Pack includes 5 handbooks

Debbie Mackaman, RHIA, CPCO, CCDS

Compliance with Medicare rules for inpatient-only procedures is a real challenge for hospitals. Staff members from patient access/registration, billing, CDI, utilization review, case management, and compliance all play a role in ensuring patients receiving these procedures are handled properly—and billed for correctly. There are also complexities related to unplanned emergency procedures and procedures that change midway through a surgery.

The Inpatient-Only Procedures Training Handbook, by nationally recognized and respected regulatory specialist Debbie Mackaman, RHIA, CPCO, CCDS,analyzes the regulations and provides practical information, strategies, and best practices for ensuring compliance and preventing denials and lost revenue. The handbook format will enable easy distribution of this critical education among departments and staff.

Table of Contents

Chapter 1: Inpatient-Only Procedure Regulations

  • What is the CMS regulation?
  • How are inpatient-only procedures identified, added, and deleted?
  • Staying up-to-date on annual changes
  • Locating the inpatient-only procedure list
  • Inpatient order requirements
  • Inpatient-only pain points


Chapter 2:
The Effects on Reimbursement

  • Performing inpatient-only procedures on outpatients
  • Critical access hospitals
  • Exceptions to the regulation
    • Separate procedure exception
    • Emergency procedure exception
  • Special implications
    • Three‐day payment window
    • Two‐midnight rule


Chapter 3: Creating Best Practices

  • Education: Start at the top
  • Outreach and communication
  • Before a procedure is performed: Scheduling and clinical staff processes
  • Before the patient is discharged: CDI, utilization review, and case management processes
  • Post-discharge: Coding, billing, and audit processes
  • Follow-up: Denials management processes
  • Encourage success


Chapter 4: Tools and Resources

  • Draft policy: Identification of inpatient-only procedures
  • Inpatient-only process chart
  • Departmental checklist for identifying inpatient-only procedures
  • Key resources


Staff members that would benefit from this resource include:

Case managers, compliance auditors/officers, HIM managers and staff, registration/patient access managers and staff, insurance verification/precertification staff, coding/billing managers, billers, business office staff, surgery schedulers, administration, VP clinical, CFO, patient financial services, physician advisors, medical executive committee, UR/UM professionals, CDI staff

About the Author

Debbie Mackaman, RHIA, CPCO, CCDS, is an instructor for HCPro’s Medicare Boot Camp®—Hospital Version and lead instructor for the Critical Access Hospital Version and Rural Health Clinic Version. She has over 24 years of experience in the healthcare industry, including inpatient and outpatient prospective payment systems; and coding, billing, and reimbursement issues for hospitals, critical access hospitals, and rural health clinics. She has served as compliance officer and director of health information services for healthcare systems.

Published May 2016