Every facility needs to create sustainable processes to ensure that devices and procedures match and are accurately presented on the claim. If doctors don’t document specifics of patient care during service, then coders will have to ask them for details afterwards, when details are more difficult to recall.
Physicians hate getting a coding query after the patient’s discharge when the coder needs to clarify what device the physician used.
It is vital that busy physicians and coders grasp what CMS’ 2014 payment changes mean, both for them personally and to the organization. Change just for change’s sake is disliked, but change required for paychecks to flow gets a better response. Clear understanding of downstream effects is vital.
In its most transformative gesture in the 2014 Hospital Outpatient Prospective Payment System (OPPS) final rule, CMS implemented a comprehensive payment method for 29 device-related procedures, although its implementation is delayed for one year until January 1, 2015. During this timeframe, CMS invites public comment on this component of the 2014 OPPS final rule. For calendar year (CY) 2014, regarding Ambulatory Payment Classification (APC), Medicare will continue to apply the current device-dependent APC rate-setting methodology to the 39 currently recognized device-dependent APCs. Until the comprehensive APC policy is implemented, CMS will continue to pay separately for procedures described by add-on codes that are assigned to device-dependent APCs.
Many of the finalized 2014 OPPS policy changes will require system edits, changes to hospital operations, and staff education, in order to prevent denied claims and audits. System edits may be required to recognize charge items that have changed from a paid status to a packaged status, such as stress agents, Cysview, and skin substitutes. CMS continues to urge that any service, drug or biological with a HCPCS code be represented on the claim if it is a resource used in patient care:
“We emphasize that hospitals should report all HCPCS codes for provided services, including those for packaged services, unless the CPT Editorial Panel or CMS provides other specific guidance. The appropriateness of the OPPS payment rates depends on the quality and completeness of the claims data that hospitals submit for the services they furnish to Medicare beneficiaries.” [OPPS Final Rule, 2014]
For more valuable insight into the changes, check out the very popular webinar, “2014 OPPS Overview,” on Appeal Academy’s Jan 10, 2014 “Finally Friday” program.
Are you providing tools and education to ensure busy physicians and coders grasp what the 2014 OPPS changes mean, both for them and to the organization?
What is your facility doing to validate that the devices and procedures are accurately documented on the claim?