Coding and Billing
Coding and billing made simple.
Compliance with Medicare coding and billing regulations, requirements and guidance is necessary for all Medicare-certified providers and suppliers, and doing so is often complex and detailed. Providers and suppliers must maintain a comprehensive understanding of all applicable payment systems, such as the Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Providers and suppliers must also understand the nuances within the numerous fee schedules applied by Medicare, such as the Medicare Physician Fee Schedule (MPFS) and Clinical Lab Fee Schedule (CLFS).
At the heart of each of these systems and fee schedules, providers must understand and correctly utilize coding mechanisms. In most outpatient settings, providers must utilize the Healthcare Common Procedure Coding System (HCPCS). HCPCS is a set of health care procedure codes representing various items and services, and is based on the American Medical Association’s Current Procedural Terminology (CPT Codes).
In most inpatient settings, providers must utilize Diagnosis-Related Groups (DRGs). DRGs make up a statistical system of classifying an inpatient stay into a group for reimbursement purposes. The DRG classification system divides possible diagnoses into major body systems then subdivides them into groups for the purpose of calculating Medicare reimbursement amounts. Similarly, Case Mix Groups (CMGs) are employed in inpatient rehabilitation hospitals or distinct units, while Skilled Nursing Facilities utilize the Patient Driven Payment Model (PDPM) to determine reimburement amounts. In both in and outpatient settings, providers must employ diagnostic coding. Diagnostic coding is the translation of written descriptions of diseases, illnesses and injuries into codes from a particular classification.
Are you prepared for coding and billing changes?
The federal government updates applicable billing and coding information (such as the fee schedules) at least annually, and providers must be prepared to embrace regulatory changes on an ongoing basis. Advis experts are positioned to respond to providers’ immediate inquiries with respect to revised fee schedules and reimbursemen policies.
Optimizing Reimbursement
The coding consultants at Advis will provide your organization with the knowledge necessary to meet the challenges presented by this vast array of billing and coding information. We will assist you to ensure operational compliance and optimal reimbursement. Advis offers numerous services in this regard, including but not limited to comprehensive coding and billing audits and the provision of education and training for your staff.
