Catalog Number : cra1614
Title : Critical Access Hospitals: Method II Billing
Speaker : Duane Abbey

Webplay Recording Date : 4-14-2016
Webplay Price : $ 150 for two weeks viewing

Webinar Overview:

The Critical Access Hospital struggles with many of the same billing and collection issues as other hospitals. Accurately billing and charging all payors is important. The Critical Access Hospital has an option that is not applicable to an acute care facility:

Standard Method versus Elective Method

• Standard Method - Cost-based facility services with billing of carrier for professional services. The Critical Access Hospital is paid under this method unless it elects the Elective Method
• Elective Method - Cost - based facility services plus fee schedule for professional services. 115 percent of the allowable amount is paid under the Medicare Physician Fee Schedule for physician professional services. Payment for non-physician practitioner professional services is 115 percent of 85 percent of the allowable amount under the Medicare Physician Fee Schedule.

Are You A Standard Payment Method or Optional (Elective) Payment Method Critical Access Hospital?

Would you answer “YES” to these questions if making the decision to opt for the Optional (Elective) Payment Method?

• Does your hospital already have the staff in place to provide additional billing services under the Elective Method?
• Does your hospital already provide the billing services for the physicians for professional fees?

Do your coders feel overwhelmed by which regulations apply to their setting, making their coding & reimbursement a particularly challenging process?

Do you know certain OPPS guidelines apply to your Critical Access Hospital, while others do not?

The Optional (Elective) Payment Method II billing and reimbursement involves using the UB - 04 claim format for filing professional component services. Reimbursement involves a number of features taken from RBRVS (Resource Based Relative Value System). Also, there are a number of unusual billing & reimbursement situations in using the Method II approach.

A LIVE Webinar at 1 p.m. Central - on Thursday, May 14, 2009

Webinar Level:

Intermediate/Advanced

Target Audience:

• CAH Coding Personnel
• Billing and Claims Transaction Personnel
• Nursing Staff
• Outpatient Service Area Personnel
• Chargemaster Coordinators
• Financial Analysts
• Compliance Personnel
• Physicians
• Practitioners and Other Interested Personnel

Prerequisites for Participating:

General knowledge of Critical Access Hospital payment along with some knowledge of CHA payment methodologies.

Webinar Objectives:

• Review the reimbursement process for the Critical Access Hospital
• Review the differences in coding and billing for the Critical Access Hospital as compared to a PPS hospital
• Understand the basic process of using and being reimbursed under the Method II approach
• Appreciate the Medicare Physician Fee Schedule (MPFS) based on RBRVS
• Review the key features of physician reimbursement under RBRVS
• Special situations encountered by the Critical Access Hospital billing for multiple physician/practitioners on the same UB-04
• Appreciate the need to carefully establish the Chargemaster and the proper use of modifiers
• Understand additional payment that can be gained from HPSA and PSA designated areas
• Appreciate the need to carefully monitor professional reimbursement under Method II

The following are a few of the topics to be discussed:

• Overview
  • The Critical Access Hospital
  • Cost - Based Reimbursement
  • Physician/Practitioner Coding/Billing
    • Method II
    • Standard Physician Coding/Reimbursement
• Method II Approach for Professional Reimbursement
  • 115% of Physician Fee Schedule (CORF Fee Schedule)
  • Organizational Structuring - Reassignment
  • HPSA and PSA Additional Payments
  • Challenges with Method II Payment
• MPFS and RBRVS
  • Relative Values
    • Work
    • Overhead
    • Medical Malpractice
  • Calculation of Payment
  • Special Features
    • Multiple Procedure Discounting
    • CCI Edits and the “- 59” Modifier
    • E/M Coding and the “- 25” Modifier
    • Families of Endoscopies
    • Pre-, Intra- and Post-Operative Periods
    • Other Features
  • CAH Challenges with Multiple Physician/Practitioners
• Tracking Reimbursement
  • Remittance Advices
  • Reconciling Payments
• Sources for Further Information

Attendance Certificate:

Upon attending this course you will receive a 1.8 Contact Hour Attendance Certificate. There is usually a reciprocal agreement between state associations to allow these to count for each state. If you have any questions, please ask your state association.

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.