Merlino Healthcare Consulting Corp.

With the plethora of reimbursement Web sites and materials available, you should consider identifying some important sites for your facilities procedures and check them regularly.

Create a folder in your favorites bookmarks called “Monthly Reimbursement Sites” and place these bookmark links in this folder. Now, you are not done yet, schedule on your calendar and spend one to one and a half hours each month reviewing these Web sites for their updated information. The first week of each month is usually a good time as CMS and others typically publish new materials during the last few days of the month.

Additionally, delete and add bookmark sites each month to this folder based on the usefulness of the site. Putting this as part of your normal routine will keep you current in manageable periodic time periods.

Available on Merlino Healthcare Consulting Corp. Web site is a page titled “Links to Reimbursement Resources” you may find some helpful links for your facility on this page. In addition to these links you may want to consider the CMS Web site specialty Web pages for Physicians or for Practice Administrators at: www.cms.hhs.gov/physicians/ or www.cms.hhs.gov/providers/pair/

When choosing your important Web sites to monitor monthly you may want to consider checking Professional Organizations and vendors important for the procedures you perform, these sites can also have helpful reimbursement information.

Finally, did you know that you can type in a word, phrase or disease name into the Web search engine Google (www.google.com) and find definitions? This can be extremely helpful if you are trying to code and need a quick definition. Check it out.

Fall is an important time for new coding and payment information to be released, are you prepared?

By now you should have received your new ICD-9-CM and CPT@ code books. We recommend you review all the site specific appropriate code and payment rate changes for the upcoming year, now. Although Medicare is an important player, do not forget to obtain and review your top private payer code and rate updates during this process. November/December is a good time to schedule a comprehensive review and update your charge description masters for the changes effective in January. Below is some important Medicare information to assist you in this process: Centers for Medicare and Medicaid Services (CMS)

NEW Final Rules and HCPCS codes published, available now, effective January 2004.

New and revised 2004 Healthcare Common Procedure Code System (HCPCS pronounced “hic-picks”) Alpha-Numeric supply, drug, radiopharmaceutical and service codes are now posted on the CMS Web site. These HCPCS codes become effective January 1, 2004 and there is a three-month grace period.

The 2004 Physician Fee Schedule (PFS) is now posted on the CMS Web site at the URL below. This rule will be published in the November 7th 2003, Federal Register. The new conversion factor (CF) will be $35.1339 which will be a 4.5% cut from the current CF. These relative value units and rates become effective January 1, 2004.

The 2004 Hospital Outpatient Prospective Payment System (HOPPS) also referred to as the Ambulatory Payment Classification System (APC) final rule is now posted on the CMS web site at the URL below. These APCs become effective January 1, 2004. There are many changes in this new evolving system, pay particular attention to the nuclear medicine section during your review as this section has changed significantly.

October 2003- Centers for Medicare and Medicaid Services (CMS) Program Memorandums

Did you know that Medicare supplies you with valuable information simply by numbering its program memorandums?

When CMS publishes a program memorandum (PM), the text is not the only helpful piece of information.

There are three elements to the numbering of a PM separated by hyphens. First is the alpha piece. If “A” appears, then this PM is directed toward hospitals and or its contractors, the fiscal intermediaries (FI). If a “B” appears, it is directed toward the physician offices or independent diagnostic imaging centers or their contractors, the carriers. If both “A“ and “B” appear in the numbering of the PM, then the information in the PM applies to both settings.

The second element identifies the year that the PM was published.

The last series of numbers is CMS’s internal identification in numerical ascending order, as the PMs are published thoroughout the year.

So if your practice is identified as a physician office setting, and someone shows you a CMS PM with an “A” in the number and no “B,” you can state that this PM does not apply to your practice. However, you may want to consider doing some research to see if a similar policy exists for your setting.

Centers for Medicare and Medicaid Services (CMS) instructions, program memorandums and transmittals can be located at: www.cms.hhs.gov/manuals/