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Our focus is on outpatient facility coding and reimbursement, but facility coders and pro-fee coders need to be aware that the facility is not the only entity that can submit claims for services performed in facilities. Physicians and other providers also report the services they perform in facilities to be reimbursed for their work.
Many municipalities contract with private ambulance and patient transport companies. Medicare and the OIG are increasing oversight activities in the ambulance billing area due to the unique requirements for ambulance coding. Medicare and Medicaid spend billions on emergency medical services, and ambulance coding is a reappearing item on the OIG’s annual worklist. The scrutiny will only get more intense as more of the postwar “baby boomers” reach Medicare age.
HCC coding relies on ICD-10-CM coding to assign risk scores to patients. Each HCC is mapped to an ICD-10-CM code. Along with demographic factors such as age and gender, insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score. Using algorithms, insurance companies can use a patient’s RAF score to predict costs.
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The Best For Your Health
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