If you only bill using the CMS-1500 claim form, then you’ve probably never seen a revenue code. But if you need to bill for facilities, you know revenue codes play an important communicative role between providers and insurers. UB-04 claim forms sent to an insurance company without a revenue code associated with each charge will be rejected.
Having taken on more diverse responsibilities, many providers regard medical coding as a necessary evil; their primary focus is caring for their patients. Although many physicians select codes for the work they perform, they rely on specialized coding and auditing professionals to review their documentation and reporting for accuracy.
The most commonly reported CPT codes are getting a much-needed makeover. Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, writes about E/M code changes implemented this year and changes for implementation over the next two years.
Healthcare organizations and providers are experiencing a shift in outpatient reimbursement: from fee-for-service to Alternative Payment Models and value-based reimbursement based on quality outcomes.
U.S. District Judge Rudolph Contreras last week reaffirmed that the U.S. Department of Health and Human Services (HHS) exceeded its authority when it made 2018 payment cuts to outpatient hospitals for certain drugs purchased through the 340B drug pricing program, and extended the ruling to 2019 payment cuts.
Reduced and discontinued service modifiers indicate to the payer when service is either less than the HCPCS code indicates (reduced) or the procedure was stopped before completion (discontinued).
Hospital coders must develop and adhere to internal E/M coding guidelines and CPT guidance to accurately report visits to the ED. In addition, because ED coding encompasses professional and facility billing, they may need to scour provider documentation to determine the correct E/M service level for both bill types.
Telehealth services are likely to promote health, wellness, and disease management, providing an avenue to offer efficient, high-quality care while supporting value-based care in a cost-effective manner. Although the benefit of telehealth is obvious and its value is continually highlighted by CMS, it appears the services are underutilized.
Provider participation in the BPCI Advanced program fell by 16% between October 1, 2018, and March 1, 2019, at the initiation of the risk-bearing phase of the voluntary payment program. Overall participation includes nearly 1,300 providers still participating, according to CMS.
