During several recent Medicare Boot Camp—Hospital Version® classes, I noticed some confusion about the four parts of Medicare. With respect to each part, there appeared to be confusion about the authority or entity responsible for determining the scope of covered services, beneficiary cost sharing, adjudication of claims, and payment for covered services. Based upon this apparent need for clarification, this is the first of three notes that will focus on the four parts of Medicare: Medicare Part A, Medicare Part B, Medicare Part C, and Medicare Part D.
Last week was a quiet week for CMS other than the release of the FY 2016 IPPS final rule on August 17 in the Federal Register. I thought I would take this opportunity to look at a billing issue about which I have recently been asked several questions. The questions generally revolve around how a hospital can bill for ambulance services when an inpatient leaves the facility for a procedure at another facility with the intention to return the same day. Unfortunately, since a hospital will trigger an edit that prevents the ambulance revenue code from being reported on the inpatient claim, it is assumed that the hospital must write off the transportation service. In fact, just the opposite is true based on CMS guidance.
One of the biggest challenges to the provider community, including hospitals and critical access hospitals (CAH), is keeping up to date with current regulatory requirements, particularly when it comes to rules on coverage, coding, billing, and payment for services provided to beneficiaries under federal healthcare programs, including Medicare and Medicaid. For those of you who have taken one of our hospital or CAH Medicare Boot Camps, you probably remember discussing this early during the week, when we identified the major official sources of authority on Medicare rules, as well as some tips about how to efficiently keep yourselves up to date.
While implementation of the long awaited and long overdue ICD-10 coding system is just around the corner, some questions still remain regarding “split billing” based on the October 1, 2015, date of service. Lately, I have been asked questions by billing staff from both PPS and critical access hospitals (CAH) so this may be a good time to clarify how and when to split bill.
The April quarterly I/OCE update from CMS did not defy convention featuring the typically small number of updates following extensive changes in the previous quarter but CMS did continue to clarify
When an NCCI edit occurs on a claim, providers can go directly to CMS’ website and download the latest edits to pinpoint why the edit occurred and what codes may be conflicting.
Q Addendum B of the APC updates for 2012 indicates the new molecular pathology codes have status indicator E (noncovered service, not paid under OPPS). Our laboratory director said we should report these new codes in addition to the codes that are payable. Can you explain why?
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