Скачать или смотреть Evaluation and Management: Inpatient and Observation Services

This is from a recording of a webinar that took place on 8/8/2024.

As part of an ongoing effort to lower SNF improper payment rates WPS continues our 5-claim reviews of each skilled nursing facility within our jurisdictions. Those reviews have led to some common review findings.

In this education we will discussed review findings for the third quarter of 2024, and how to avoid them.

Resources:
Social Security Act §1862 (https://www.ssa.gov/OP_Home/ssact/tit...)

CMS IOM Publication 100-03 National Coverage Determinations (NCD) Manual, Chapter 1, Coverage Determinations, Part 1, Section 70.3 (https://www.cms.gov/regulations-and-g...)

Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Physicians Non-Physician Practitioners Section 30.6 (https://www.cms.gov/regulations-and-g...)

CMS MLN006764 E/M Services (https://www.cms.gov/outreach-and-educ...)

CMS MLN901705 Telehealth Services (https://www.cms.gov/files/document/ml...)

Medicare Physician Fee Schedule Relative File (https://www.cms.gov/medicare/payment/...)

NCCI Procedure-to-Procedure Edit files ( https://www.cms.gov/medicare/coding-b...)

NCCI Policy Manual (https://www.cms.gov/medicare/coding-b...)

List of Telehealth Service (https://www.cms.gov/medicare/coverage...)

WPS YouTube E/M Playlist (   • Evaluation and Management (E/M) Services  )

WPS YouTube Modifier Playlist (   • Modifiers  )

Chapters
00:00 Intro
03:43 Defining medical necessity
05:09 Choosing a procedure code
06:06 Same physician
07:50 Same day procedures
13:02 E/M per diems
15:19 Observation care
20:03 Inpatient care
33:03 Social Determinates of Health
34:34 Pronouncement of death
35:10 Prolonged care
36:22 Patient status change
38:24 Telehealth
41:15 Split Shared Services
43:12 Claims data
43:53 Common rejections
46:08 Common denials
50:22 Resources
51:18 Questions
57:56 Closing comments