Medicare covers observation care as an outpatient service under Part B payments. (Medicare reimburses different healthcare providers under different systems or parts—Part A for hospital payments, Part B for medical/doctor’s services,...Read More »
Inpatient coders are familiar with risk-adjusted methodologies—where a combination of diagnoses lead to higher-weighted code groupings--but many outpatient coders may not have encountered them.
That's likely to change as hierarchical condition category (HCCs)
CDI specialists typically review inpatient records to obtain specificity related to principal and secondary diagnosis. As a profession, such staff combine clinical knowledge with coding, billing, and documentation experience. Although not as prevalent as inpatient efforts, outpatient CDI is a...Read More »
Auditors have been reviewing medical necessity for inpatient services for years and Recovery Auditors (RA) have recouped millions of dollars in overpayments. Now outpatient providers are beginning to see more and more medical necessity audits, especially in the ED and for evaluation and...Read More »
Q: Do you recommend carving out time for outpatient [documentation] review, or dedicating someone to this role?
A: We actually carve out time for outpatient review. We started with two initiatives in our ED. One was injections/infusions and documentation...Read More »
