FRIDAY October 24, 2014
Securing Orders for
Inpatient-Only List Surgeries:
Two Hospitals Reveal How They
Insure They Get What They Need
How Do You Do It & How Might You Improve?
Despite much discussion and review of the subject, there is confusion about how a claim billed with a surgical procedure clearly listed on CMS’s Inpatient-Only List can be denied as inappropriate for Part A payment. Unfortunately, there are several “moving parts” so to speak, for these types of claims, and they cause confusion, among payers as well as providers.
Why? Because the system we are stuck with is confusing, confused and… well, it needs to be completely overhauled. (Or as one of the images to the right suggests, it needs to be blown up, so we can start over.)
But we don’t have such luxury, so we have to live in the present and find a way to survive, until such time that a new system resolves everything. (How about ICD-45? 46? Surely, it won’t happen with a mere Transmittal…)
This we’ve asked two hospitals to give you a review of their processes, which at least work for the most part (no one has a perfect system), and allow you and our panelists to ask questions, get advice, and discuss options. Also, we will give a short description of how our panel of experts would recommend you try to proceed, in an effort to at least improve your own results.
…Handouts are available on the Replay page…
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