Inappropriate billing and payer denials for services performed at hospital-based departments and clinics are a struggle for hospitals. These claims are closely reviewed by the Medicare and Medicaid Offices of Inspector General (OIG, OMIG) and increasingly for the Recovery Audit Contractors (RACs). Determining the appropriate type of bill (technical, professional or both) and which codes to bill on which claim affects the financial reimbursement for the claim. Professional and technical hospital billing staff and coders must work together to ensure appropriate charging and billing for these services. This presentation will address some of the challenges facing hospitals today as they increasingly acquire professional practices as hospital-based clinics.
Identify the risks surrounding billing for hospital-based departments
Determine whether a service should be billed professionally or technically or both
Apply basic regulatory indicators for making a determination
Explain how to analyze the impact of acquiring a hospital-based clinic
Discuss case studies and how to report them
Who Should Attend
Coders, CDI Specialists, Coding Managers, HIM
This replay was recorded on May
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