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Back to Basics: APC Payment Methodology

Author: Tomak, Tracey

Source: CodeWrite | AHIMA newsletter article

Publication Date: April 2017



In August of 2000, the Centers for Medicare and Medicaid Services (CMS) introduced the Ambulatory Payment Classifications (APCs) under the Outpatient Prospective Payment System (OPPS). The objective of the APC payment system was to control costs and increase efficiencies for outpatient ser....

CY 2017 OPPS Update

Author: Comfort, Angie

Source: Journal of AHIMA - Coding Notes | Journal of AHIMA

Publication Date: February 2017



As last year drew to a close, facilities began the looming task of reviewing the Hospital Outpatient Prospective Payment System (OPPS) final rule to ensure their chargemaster and systems were up-to-date with the 2017 changes. The final rule for calendar year (CY) 2017 was released on Novem....

New Changes De-Spookify Modifier -59

Author: Wilson, Donna D

Source: Journal of AHIMA - website

Publication Date: October 30, 2014



The proper application of modifier -59 (Distinct Procedural Service) has mystified many a coder. The Centers for Medicare and Medicaid Services (CMS) has recently indicated that modifier -59 is the most commonly used and abused of all the modifiers—mainly due to the fact that it is used to....

Modifers – ‘Friend or Foe’

Author: Swindle, Jennifer

Source: AHIMA Convention

Publication Date: October 02, 2011

ABSTRACT:

Background: The need for modifiers to further and appropriate identify accurate coding information to all payers is critical for appropriate and accurate reimbursement. Failure to use modifiers can have a negative impact on a physician or an organizations’ revenue as witho....

Spinal Surgery in CPT/HCPCS Unraveled

Author: Kuehn, Lynn

Source: AHIMA Convention

Publication Date: October 02, 2011

Introduction

Spinal surgery can involve a combination of nervous system and musculoskeletal system procedures. Understanding the definitions, anatomy and procedure concepts of these systems provides a foundation for use by the coder in correctly assigning codes in multiple classification....

Observation Services

Author: Hapner, Peggy

Source: AHIMA Convention

Publication Date: September 25, 2010



Observation is a necessary, though cumbersome, service provided in hospitals today. Many facilities would like to see observation eliminated because it is a logistical nightmare, particularly when it comes to charges and reimbursement.

The most stringent rules about observation....

Key Issues in the 2009 OPPS Final Rule

Author: Clark, Andrea

Source: Journal of AHIMA - Coding Notes

Publication Date: March 2009


The final rule for the 2009 Outpatient Prospective Payment System (OPPS) includes multiple revisions that hospitals must address in their practices, policies, and operations. Hospitals should develop strategies for analyzing the financial impact and operational challenges by reviewing the foll....

Coding Radiology Services

Author: Walk, Gerri

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2009


Because coding and radiology departments often share accountability for the quality of outpatient radiology coding, it is important that coding professionals share coding issues and charge capture expectations with radiology staff. This article outlines methods to improve the quality of coded....

Web FAQ

Author: AHIMA Coding Team

Source: AHIMA Q and A

Publication Date: October 2002

Who Has the Official Guidelines for Interpretation of Coding Guidelines or Appropriateness of Code Assignment?
For ICD-9-CM coding questions and guidelines we look to Cooperating Parties for ICD-9-CM. The National Center for Health Statistics and the Health Care Financing Administration receiv....

Testimony of the American Health Information Management Association to the National Committee on Vital and Health Statistics on Medical Code Sets

Author: Prophet, Sue

Source: AHIMA testimony and comments

Publication Date: February 06, 2002

February 6, 2002
Opening Comments

Good morning Mr. Chairman, members and staff of the National Committee on Vital and Health Statistics (NCVHS) Standards and Security subcommittee, ladies and gentlemen.   I am Sue Prophet, director of coding policy and compliance for the American Heal....

Making a Proactive Transition to APCs

Author: Willett, Lyn

Source: Journal of AHIMA

Publication Date: July 2000


There's no doubt APCs are going to change the way your facility operates, but do you know how? By taking a look at your existing systems, you'll get a better idea of how to prepare for changes. This article spotlights specific functions to consider and optimize for the new outpatient prospect....