The New Year will usher in significant "must-know" changes to the Medicare program, including reporting credits for implantable medical devices and managing patient accounts when such devices are reported (billed). A favorite target area for numerous federal auditing entities including, but not limited, to the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), RACs, ZPICs, CERT, and the individual MACs (e.g., Noridian, WPS Medicare, NGS & CGS, Palmetto, et al). Medical device credits are still an easy mark for all auditing entities. Plus, intense scrutiny only promises to continue in this confusing, error-ridden area of reporting for hospital inpatient, hospital outpatient, and ambulatory surgery centers (ASCs) services.
Further clouding the picture for accurate reporting are newly invigorated OIG audits with a specific target: APC outlier payments related to implantable medical device credits. Have you received outlier payments? Do you even know if you are receiving these additional federal dollars? A recent poll revealed many aren't even aware of this potential risk area!
Wait! There's even more: added to those sticky areas are obscure device requirements mandating the reporting of credits for initially-placed devices (i.e., not replacement devices) for outpatient cases and a special Condition Code that goes along with the claims.
Join healthcare expert Michael Calahan as he walks you through all the traps that can snare your facility or ASC when reporting device credits.
Why This is Relevant:
As the OIG has stated, "Every facility we audit has billing errors with replacement device credits." For 2020, the types and numbers of devices that must be reported with credits have greatly expanded due to "threshold qualifier" changes that were revealed via the Final Rules. With many more devices to monitor, there are more credits to assess and more patient accounts to manage... potentially resulting in more errors!
- The newest target area favored by the OIG
- 2020 rules and regulations as well as Medicare program changes for mandatory implantable medical device credit reporting
- How to identify which devices get reported when a credit is received
- Correct reporting of credits in each of these settings— hospital Inpatient, hospital outpatient and ASC
- The rules for initially-placed (not replacement) implantable devices, which device credits are reported in this category, and appropriately reporting CC-53
- Proper ASC reporting, including the confusing device credit modifiers, targeted devices, and common errors
Who Should Attend:
C-suite executives; HIM directors, coding managers, staff and billers; revenue cycle personnel including directors, managers and billers; compliance officers, auditors; operating room directors and managers; cardiac cath lab directors and managers; vascular lab directors and managers; interventional radiology directors and managers; neurosurgical personnel; and ASC directors.
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