Catalog Number : cra1071
Title : Observation: Coding, Billing and Financial Impacts
Speaker : Duane Abbey

Webplay Recording Date : 6-14-2017
Webplay Price : $ 150 for two weeks viewing

Webinar Overview

This Webinar is devoted to the observation services with an emphasis on coding, billing and financial impacts with the development of the observation C-APC (Comprehensive APC) under the Medicare OPPS. Observation continues as a problem area relative to proper coding, billing and documentation particularly in relationship with the propriety of inpatient admissions. CMS through the OPPS has developed a packaged payment process using a C-APC that makes a blanket payment of observation services. Whether hospitals even recover their costs under this packaged approach is problematic given the extreme variability of services and the host of challenges with determining proper inpatient admissions. The reimbursement differences between a short inpatient stay versus observation will also be discussed.

Target Audience:

Outpatient Nursing Staff, Medical/Surgical Nursing Staff, Nurse Managers, ED Nursing Staff, Utilization Review Personnel, Quality Assurance Personnel, Quality Assurance Personnel, Physicians, Non-Physician Practitioners, Coding Personnel, Billing and Claims Transaction Personnel, Chargemaster Coordinators, Financial Analysts, Compliance Personnel, and Other Interested Personnel

Webinar Objectives:

• discuss the concept of observation and associated services
• review how documentation must support the coding and billing process
• explain how observation differs from inpatient admissions
• discuss the medical decision making relative to the over 2-midnights rule
• review the need to track hours of observation including intervening services
• review the use of standard observation protocols or care paths
• explain why Medicare is so concerned about post-surgery observation
• discuss the use of C-APC 8011 in payment for observation under the OPPS
• review how Medicare reimbursement is affected by a procedure performed after observation
• discuss whether or not a given hospital is even being paid their costs for observation services
• review the variability in costs of providing observation service under differing circumstances
• recall the differences in reimbursement between a short stay inpatient encounter and an observation encounter
• discuss how private payers view and use observation services
• review the requirements in the NOTICE Act

Webinar Overview:

• Observation Services
  • Types and Levels of Services
  • Organization and Provision of Observation Services
    • Dedicated Units
    • Medical/Surgical Floor Beds
  • Coding, Billing and Payment for Observation
  • Distinguishing Inpatient from Outpatient Observation
    • Over 2-Midnight Rule
    • MOON Form
  • Physician Supervision
• Coding and Billing Considerations
  • Condition Code 44
  • Surgeries Along With Observation
  • Counting Hours
  • Direct Admissions
  • Care Paths
• Financial Considerations for Observation Services
  • Use of C-APC 8011
  • Variability Within Observation Services
  • Developing Financial Models
  • Inpatient Payment versus Observation Payment
  • Hospital Specific Payment versus Overall Observation Payment
• Auditing Observation Services
  • Developing Audit Guidelines
  • Preparing the Documentation Package for Observation
  • Conducting Mock Audits
• Private Payer Consideration for Observation
  • Changing Inpatient to Observation
  • Documenting Requests From Private Payers to Change Inpatient to Observation
• Special Considerations
  • RAC Audits
  • Coordination With ER Services
  • Coordination With Inpatient Admissions
  • NOTICE Act and MOON Form
• Sources for Further Information

Contact Hours:

• Nursing participants: Instruct-online has approved this program for 1.8 contact hours, Iowa Board of Nursing Approved Provider Number 339. Completion of offering required prior to awarding certificate.

• All other participants: Must attend the entire Webinar and complete a Webinar critique to receive a 1.5 Hour Attendance Certificate for each program.

Full tuition is refunded immediately on request if the participant has not been sent the program materials and instructions. Once the instructions (including access codes) have been sent, a full refund will be issued only after the program runs and it is verified that the participant did not access the program.