Inpatient-Only Billing (Audio Conference)

AUDIO CONFERENCE ON CD OR AUDIO ON-DEMAND

Sponsored by Medicare Boot Camp – Hospital Version

presented on October 29, 2008

Billing for services designated as inpatient-only when a person is initially admitted on an outpatient basis is tricky business. Medicare has strict inpatient-only billing procedures. Failure to follow these procedures can result in delayed or reduced reimbursement or fraudulent claims. However, many hospitals and physicians are not aware of documentation requirements or billing procedures for inpatient-only procedures began or performed on an outpatient basis.

Inpatient-only billing problems are solvable

Learn to manage the complexities of inpatient-only billing and proactively combat Medicare denials. Listen to HCPro's 90-minute audio conference, In-patient Only Billing: Understand the Rules, Identify Exceptions, and Educate Staff. Experts Kimberly Anderwood Hoy, JD, CPC. (HCPro, Inc.), and Donna Wilson, RHIA,CCS show you how to comply with Medicare's inpatient-only billing requirements in circumstances where procedures begin or are performed on an outpatient basis. You will discover methods to educate clinical and billing staff on the importance of following Medicare guidelines, lists you can use to identify inpatient-only services, and how the use of technology—such as physician portals—can enhance your compliance.

AT THE END OF THIS AUDIO CONFERENCE YOU WILL BE ABLE TO:

• Use the inpatient-only list to determine which services Medicare restricts to the inpatient environment
• Determine how to apply modifier CA correctly
• Identify when to bill inpatient-only procedures started on an outpatient basis on an inpatient claim
• Identify inpatient-only separate procedures that will not trigger a payment denial when billed on a claim with another outpatient procedure
• Determine how to operationalize the inpatient-only rule on both a large and small level
• Identify the reason for billing inpatient-only procedures even if no payment is expected
• Recognize the Recovery Audit Contractor (RAC) automated reviews of inpatient-only procedures

AGENDA

• Medicare's inpatient-only rule in the outpatient surgery setting
• Payment implications
• Policy behind the rule
• Identify exceptions to the inpatient-only rule
• Use of modifier CA
• Separate procedures list
• Recent CMS discussion on the inpatient-only rule
• Some background on the agency’s discussion regarding inpatient-only procedures started on an outpatient basis
• Educate and increase awareness of inpatient-only rule
• Strategies to communicate with case management, scheduling and clinical staff (including physicians and office staff)
• How coding staff and Patient Financial Services can set up internal edits to flag Medicare inpatient-only procedures that are assigned on outpatient patient type
• Tools and mechanisms to operationalize the rule
• Suggestions on how to computerize efforts to enable physicians and office staff access to the patient status daily
• Ways to develop an initial order set to allow ease in selection of correct patient status
• Strategies to list the most common Medicare inpatient-only procedures on hospital internal web site
• Question and answer session

BONUS MATERIALS

In addition to the expertise and advice presented during this audio conference, you'll also receive a slide presentation of the program materials and:

• Addendum E: A list of current inpatient-only procedures
• Proposed inpatient-only procedures for 2009
• A list of separate procedures that override the inpatient-only rule when they appear on the claim as an outpatient procedure

These materials are provided with PDF links.

MEET THE SPEAKERS

Kimberly Anderwood Hoy, JD, CPC.Ms. Hoy is the director of Medicare and compliance for HCPro, Inc, Prior to joining HCPro, she was the lead instructor for HRAI's Medicare Boot Camp® - Hospital Version. Hoy has served as a compliance officer and in house legal counsel for hospitals and has developed and implemented corporate-wide compliance programs for two hospitals.

Donna Wilson, RHIA, CCS. Ms. Wilson is a 25-year coding veteran who has worked her way through the coding ranks, serving as coding supervisor, coding compliance officer, and revenue integrity manager. She is the Coastal Region of South Carolina coding roundtable coordinator and was a speaker at the 2006 AHIMA national convention in Denver. She also has experience with the Recovery Audit Contractors (RAC) in the state of South Carolina.

WHO SHOULD LISTEN?

Professionals based in hospitals, who have the following position titles or work in the following departments:

• PFS/business office director
• Patient access director
• Revenue cycle manager
• Billing and coding manager
• Reimbursement professional
• CFO
• Compliance professional
• Nurse manager
• RAC coordinator
• Health Information Management
• Case management
• Surgical department

PROGRAM MATERIALS:

Program materials are provided with PDF links.

AUDIO ON-DEMAND

In addition to the regular purchase options for HCPro audio conferences, we are pleased to offer another option, an 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. Purchase a CD or audio on-demand 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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