CMS is proposing significant changes to certain appeal processes for Medicare beneficiaries. In this Q&A, Kimberly A. Hoy, JD, CPC, director of Medicare and compliance for HCPro LLC, in Chicago, explains how the rule could affect hospitals, including new required notices and potential billing process updates, and strategies for managing patient status changes.
Q: If an anesthesiologist performs a presurgical or postsurgical block for pain control and it is performed in a holding area rather than in the operating room (OR), can we bill a separate facility (technical) fee for that? Or would this be bundled with OR services?
Q: My team and I are responsible for clinical documentation improvement (CDI). We’re considering adding a reconciliation element to our CDI review process next year. In your experience, what’s been the biggest benefit of performing reconciliation on charts?
Q: We are a critical access hospital (CAH). We provide smoking cessation therapy (CPT codes 99406-99407) in our cardiac rehab department. The documentation is done and signed by a respiratory therapist (RT), and we are currently billing this as a professional charge (on a UB-04 with revenue code 0981). My question is, can we bill this on a UB-04 as a facility charge only and still allow our RT or other ancillary staff to perform it?