Use this handy checklist as you update your facility for the Second Quarter.
April is the beginning of a new quarter, and a checklist is offered for tasks at your facility.
- Review the April 2022 update of the Hospital Outpatient Prospective Payment System (OPPS) – Transmittal R11305CP. This document reviews COVID vaccine and treatment CPT® codes, new Proprietary Lab Analyses codes, Device offsets, new Healthcare Common Procedural Coding System (HCPCS) codes and corrections to HCPCS codes. The document is thirty-one pages long.
- Review the April 2022 Integrated Outpatient Code Editor specifications – Transmittal R11304CP. This forty-eight-page document provides updates to diagnosis codes, Ambulatory Payment Classifications, HCPCS codes, and modifiers.
- Analyze the ICD-10-PCS New Technology list. Have there been any changes in services, substances, or devices at your facility? Are they on this list? If so, provide education to the coding staff regarding the changes and where to find the documentation. Update your facility-specific coding guidelines to correlate with these changes.
- Review your Diagnosis Related Group (DRGs) denial trends. Targeted physician and/or coder education or a query update may be an initiative-taking step to avoid these denials. You may want to meet with the contracting team to provide feedback for information to include in upcoming contract negotiations, such as criteria to be used for determining sepsis. You also may want to include your physician advisor in the education process.
- Review your Medicare Administrative Contractor’s (MAC) website. Look for the medical policies and education offerings. For instance, I live in Pennsylvania and the MAC is Novitas. This MAC is offering multiple education sessions via webinar in the month of April. I can also find a list of proposed medical policies.
- Analyze the workflow for the Unspecified Code Edit (MCE #20). Is the process working for those who are involved? What is the frequency of this edit? If you have a high frequency, then you need to educate the coders or CDI staff to be querying for laterality on the unspecified laterality codes. Are the remarks printing in the Remarks section of the UB-04?
- Update your facility-specific coding guidelines for any changes beginning with April 1 and maintain a copy of the previous guidelines for any audits conducted in that period.
This list is really a quarterly to-do list to ensure that you are prepared for the revenue cycle changes. These updates involve the leadership of the CDM, Coding, CDI, Revenue Cycle, HIM, Patient Access, Case Management/Utilization Review, and Business Office Manager to develop a pro-active process for each quarter.
The quarter checklist should be completed prior to the beginning of the next quarter. Remember that the vision for the American Health Information Management Association (AHIMA) is a world where trusted information transforms health and healthcare by connecting people, systems, and ideas.