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Billing updates aim to help physician offices get paid for CAR T-cell therapy. The latest round of updates to HCPCS Level II coding clarifies outpatient billing requirements for chimeric antigen receptor (CAR) T-cell therapy, an often curative treatment that uses a patient’s own genetically modified immune cells to fight cancer. The key takeaway is that […]
The post Check Out These Changes to Outpatient CAR-T Coding appeared first on AAPC Knowledge Center.
Know when to assign diagnosis codes for chronic conditions. While assigning diagnosis codes for chronic conditions may seem straightforward, some confusion remains regarding which conditions should be coded in the outpatient setting. Medical coders are responsible for assigning ICD-10-CM codes for all diagnoses made by a healthcare professional that affect the patient’s care. These codes […]
The post Capture Chronic Conditions in the Outpatient Setting With Confidence appeared first on AAPC Knowledge Center.
The shift to outpatient services puts billers and coders with an understanding of the OPPS in demand. Hospital outpatient services are all services provided to a patient in a facility that do not require inpatient admission. Outpatient is defined by the Centers for Medicare & Medicaid Services (CMS) as: “A person who has not been […]
The post Brush Up on Outpatient Billing and Coding Basics appeared first on AAPC Knowledge Center.
In accordance with Centers for Medicare and Medicaid Services (CMS) guidelines, Horizon BCBSNJ requires that claims for clinical laboratory services report the referring practitioner on the claim submission. This applies to participating and non-participating providers.
Effective November 15, 2019 Horizon BCBSNJ will change the way consider and reimburse certain clinical laboratory claims that do not include information about the referring practitioner information.
Based on the guidelines of this reimbursement policy, Horizon BCBSNJ will deny outpatient claims submitted by participating or nonparticipating clinical laboratories for services provided on and after November 15, 2019 if the referring practitioner information is not included.
To avoid claim outpatient clinical laboratory claim denials, include referring practitioner information as noted below,
To address claims denied for no referring practitioner information, clinical laboratories will have to submit a corrected claim that includes this required information. Until such time as this corrected claim information can be submitted and processed, members cannot be held liable for services related to these claim denials.
Source: https://www.horizonblue.com/providers/news/news-legal-notices/reimbursement-policy-implementation-outpatient-laboratory-claims-referring-practitioner-required
Knowing when and how to query providers is key. Documentation deficiencies occur in both outpatient and inpatient settings, but clinical documentation integrity (CDI) programs have been implemented primarily in the inpatient setting only. Poor documentation can impact code assignment, reimbursement, and patient care in any setting. As most organizations strive for excellence in these areas, […]
The post Build a Successful Outpatient CDI Program appeared first on AAPC Knowledge Center.
With or without a rhyme or reason, you can count on coding changes popping up throughout the year. In addition to April updates to the Medicare Physician Fee Schedule (PFS), providers billing under the Outpatient Prospective Payment System (OPPS) should be aware of four new CPT codes, a new advanced diagnostic laboratory test, additions to […]
The post April Showers Bring Outpatient Coding Changes appeared first on AAPC Knowledge Center.
Does anyone have knowledge of a policy that supports the use of MSR (reductions) on outpatient facility claims. This has been a recent hot topic to us locally and I am looking for all the knowledge I can gain.
Thank you!