Welcome to the May edition of Net Revenue Matters, a publication of CentraMed.

Transcription

1 Net Revenue Matters May 2012 Welcome to the May edition of Net Revenue Matters, a publication of CentraMed. In his article, Joining the World Community, Executive Vice President Jack Duffy discusses secure patient identification and lifetime health information access. We hope that you will appreciate the information presented in our additional articles: MACS/FICS Hold Claims..., CMS Medicare Quarterly Provider Compliance Newsletter, and Q&A: CPT Coding of Prefabricated Splints. Also, please be sure to note our client corner and upcoming events. We don t want you to miss anything. Inside this issue: Joining the World Community 1 MACS/FICS Hold Claims Containing CPT Code and HCPCS Code C CMS Medicare Quarterly Provider Compliance Newsletter 2 Q&A: CPT Coding of Prefabricated Splints 3 Client Corner Best Practice Forum Wrap-Up 4 Joining the World Community In recent years, we saw the developing nations of the world skip the expense of constructing millions of miles of copper to connect a billion phones. The jump to cell phones created the digital highway ten times faster than the U.S. Changes in the way health records are stored and transported may represent the next technology leap, leaving America awash in less functional paper records. Last week, several CentraMed team members engaged in a discussion called, do you know where your health records are? These veteran healthcare leaders could not answer that question for themselves or their family. As the genetic predisposition to acquire certain diseases is studied, your health record can become an important part of a future treatment/prevention plan. Countries such as the Philippines, Panama, and Columbia may not be commonly thought of as bastions of high-tech; however, as with cell phones, they are making the leap to universal identification and lifetime storage of health records. At the CentraMed Best Practice Forum hosted last week in Chicago, the participants were updated on the progress of PatientSecure. Now exceeding six million people, this innovative technology is allowing lifetime positive identification for pennies per registration. The PatientSecure ROI indicated that savings due to the elimination of duplicate medical records can easily pay the system costs. Do you know where your health records are? Next month, CentraMed s international division will begin collecting and encoding health records for thousands of students in the Philippines. This K-12 program will be the foundation of a lifetime health record and has the support of multinational technology companies and the highest levels of government. When coupled with CentraMed 2714 Loker Avenue W., Ste 200, Carlsbad, CA Phone: (760)

2 a technology-based identification process, the next generation in the Philippines and other countries will never be at a loss when trying to locate critical health information. If you share the vision of helping your organization and community take an active role to obtain secure patient identification and access to lifetime health information, please contact CentraMed to learn how this can work. CentraMed s Star Care, when partnered with a solution partner such as Patient- Secure, represents a world-class opportunity to take your message to your local school system and the community at large to make a bold statement for the use of cutting edge technologies to bring the reality of personal health records to life. MACS/FICS Hold Claims Containing CPT Code and HCPCS Code C1882 Per CMS technical direction letter (TDL) 12315, the procedure-to-device edit files included in the January, 2012 (V13.0) and April, 2012 (V13.1) Integrated Outpatient Code Editor (I/OCE) does not allow the device described by the Healthcare Common Procedure Coding System (HCPCS) code C1882 (Cardioverter-defibrillator, other than single or dual chamber implantable) to satisfy the edit in place for CPT code (Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber). Claims with dates of service between Jan 1, 2012 and June 30, 2012, for the device described by HCPCS code C1882 when used in conjunction with the procedure described by CPT code 33249, will be suspended until V13.2 of the I/OCE is installed on July 2, The July 2012 I/OCE (V13.2) will be updated with a new procedure-to-device edit file that will allow HCPCS code C1882 to be billed with CPT code All suspended claims will be released to process in the order in which they were held. CMS Medicare Quarterly Provider Compliance Newsletter Every quarter, CMS issues the Medicare Quarterly Provider Compliance Newsletter to help providers understand the major findings identified by MACs, RACs, ZPICs, CERT and other governmental organizations. The newsletter describes the problems found, any issues that may occur as a result, steps CMS has taken to make providers aware of the problem, and guidance to providers to help avoid the issue in the future. This issue, April 2012, includes two CERT items and six by RAC which impact inpatient hospitals. We ll look briefly at two of the RAC issues. You can find the entire newsletter at the path below. Learning-Network-MLN/MLNProducts/Downloads/ MedQtrlyComp_Newsletter_ICN pdf Cholecystectomy Incorrect Secondary Diagnosis This review was an MS-DRG Validation, looking at MS-DRGs The principal diagnosis, secondary diagnoses identified as CC/MCC and principal procedure were reviewed to ensure they were present, correctly sequenced, coded, and clinically valid along with the correct POA indicator for each diagnosis. The finding of this review was a secondary diagnosis not supported by medical documentation, resulting in the loss of a CC which changed the MS-DRG. The guidance provided for avoiding this problem includes coding only those conditions documented by the physician. Per the coding guidelines and the UHDDS definitions, do not code diagnoses which are not documented in the record Net Revenue Matters - May 2012

3 Kidney and Urinary Tract Disorders Incorrect Principal Diagnosis This review was an MS-DRG validation which requires that the discharge diagnoses and procedures, along with the discharge status reported on the claim, match the attending description and information contained in the medical record. The example provided in this case was that the claim was billed with a principal diagnosis of complication due to indwelling catheter, however the physician did not link the infection to the device. Therefore, the auditor changed the principal diagnosis to UTI. This resulted in an MS-DRG change from 700 to 690. To help providers avoid payment denial, they must ensure that the principal diagnosis and secondary diagnoses be sequenced correctly and the correct POA assigned. To help providers avoid payment denial, they must ensure that the principal diagnosis and secondary diagnoses be sequenced correctly and the correct POA assigned. All medical documentation entries must be consistent with other parts of the medical record and any inconsistencies should be queried. And, finally, the claim must match both the attending s description/diagnosis. Q&A: CPT Coding of Prefabricated Splints Q. Could you help us clarify if we can separately code/charge for a clavicle strapping, knee immobilizer, shoulder immobilizer, sling, or splint that is prefabricated? Some coders at our facility are arguing that prefabricated devices cannot be reported. A. The AMA does not consider prepackaged or prefabricated splints like air splints or Velcro splints or prefabricated immobilizers to be separately reportable. CPT Assistant June 2010 page 8 states that application of an air splint is not a separately coded service. Also, CPT Assistant May 2009 page 8 states that knee and shoulder immobilizers are typically prefabricated and would be considered splints; this article goes on to say that splint application requires creation of the splint in order to be separately reportable. Therefore, it would be inappropriate to assign a splint application code for a prefabricated splint or immobilizer. In the past, the AHA in Coding Clinic for HCPCS had contradicted this advice. In Coding Clinic for HCPCS 1 st Qtr page 9, the AHA wrote that the splint application code could be reported regardless of whether the splint was created at the time of application or if the splint involved was a prefabricated type like an air splint or Velcro splint. This created some conflict with CMS because, even though Coding Clinic for HCPCS is supposed to represent official coding advice for CMS outpatient claims, most local CMS contractors will not reimburse the splint application code if the splint involved was of the prefabricated variety. More recently, the AHA has apparently backed off its earlier position and has given advice more in line with CMS contractors and the AMA. More recently, the AHA has apparently backed off its earlier position and has given advice more in line with CMS contractors and the AMA. In Coding Clinic for HCPCS 1 st Qtr page 2, the AHA wrote that an air cast (or splint) would not be separately reportable. The article also states that this advice supersedes any previously published advice. In short, then, if a splint, immobilizer, strapping, or sling is not prefabricated and requires more physician work to create the device, then the application of the device may be separately reported. If the device is prepackaged or prefabricated and the amount of physician work to apply the device is minimal, then the application of the device would be considered implicit in the E & M code and HCPCS supply code and the application itself would not be separately coded. Net Revenue Matters - May

4 Client Corner 2012 Best Practice Forum Wrap-Up Our 2012 Best Practice Forum was held in Chicago, Illinois last week. Nineteen hospitals/hospital systems were represented, along with guest speakers and CentraMed associates. In total, 54 participants joined us for our annual event. Once again, process improvement was a key focus of the event with attendees voting for each process improvement initiative based on applicability, departmental interaction, economic impact/cost, ease of implementation, and metrics/measurability. Congratulations and Thank You 1st Place: West Georgia Health Presented by Margaret Barding & Scott Crawford Full Circle Accountability - Broken Link Education 2nd Place: Lake Charles Memorial Hospital Presented by Pansy Gabbard Cash is Queen 3rd Place: St Francis Medical Center Presented by Gina Edmondson & Tara Sartor Process Improvement Our Journey Another Thank You Revenue Management Presented by Lynn Johnson, Archbold Central Referral Network Presented by Chris Butler, Floyd Value Stream Analysis Presented by Pam Green & Pam Thomas, St Joseph Journey to Excellence Presented by Rebecca Clause, Lafayette Please watch the Clients area of our website for presentation copies. Thanks to all who attended and shared insight, experience, and knowledge. Please Note All CBR (Code-Based Reimbursement)/CCDR (Compliant Coding and Documentation Review) activity for the month must be entered into the CBR/CCDR Software applications, including DRG Catalyst, prior to the 10th of the following month. Be sure to follow the steps below so that results from retrospective CBR/CCDR audits translate onto the Executive Summary: Inpatient (DRG Catalyst) The rebill checkbox must be checked. (Please make sure that you send the checked accounts to PFS for rebilling!) Outpatient (CBR Database) The completion date must be entered under the CBR/CCDR Utilities tab, and The rebill checkbox must be checked. (Please make sure that you send the rebill accounts to PFS for rebilling!) Before the database closes each month, we recommend that you complete the following checklist: Confirm that all completed retrospective audits for the month have an end date entered into the CBR/CCDR database. Check the rebill box in the CBR/CCDR database or DRG Catalyst for each retrospective claim that has been approved for rebilling. Complete a Summary of Audit Findings form for any projects you closed this month and submit it to the coding Subject Matter Expert (SME). Ensure that data is entered for all accounts audited for the current month Net Revenue Matters - May 2012

5 Upcoming Client Corner Webinars Client RMD/RID Webinars Jun 5: PI Forum Jul 10: Coding Forum - ICD-10 Potential Topics Consumer-Driven Healthcare/Pay for Performance Medicare Managed Care Auditing ICU Accounts How to Handle Adversity Silent PPOs How to Interact with Internal Customers Write-Off Analysis Software Reporting Injections and Infusions Introduction to Inpatient Audits Inpatient Mechanical Ventilation POA and HAC Device Dependent APCs Observation and One-Day Stays Pain Management Outpatient Orders Spine Surgery Chemotherapy Pathology Brachytherapy Moderate Sedation Radiology Imaging Erythropoiesis Stimulating Agents Discharge Dispositions Emergency Department Vascular Access Devices Neurostimulators Please watch for your invitation approximately three weeks prior to the scheduled event. Thank You Net Revenue Matters is a monthly publication of CentraMed and is offered as an informational service. Due to the nature of this publication, examples cited and advice given must often be general in nature and may not apply to a particular facility or situation. Thus, CentraMed does not warrant or guarantee that the information contained witihin will be applicable or appropriate in all situations. Each facility will need to evaluate its specific opportunities and take such action as to best meet its business needs. To find out more about a given subject or for information tailored to your specific circumstances, contact a CentraMed professional. If you have questions or would like to submit information for a future newsletter, please contact: Cynthia Hufferd chufferd@centramed.co Net Revenue Matters - May