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Written by: Darlene D'Altorio-Jones (1959-2015) on Wednesday, August 14, 2013 Posted in: Outpatient Rehab

MedLearn Matters has added educational instruction to claims-based outcomes reporting. If you need just a little more information than MedLearn Matter article MM8005, this ten page SE1307 release has updated information under the following headings:

Background Purpose
Reporting Requirements
Reporting Period and Reporting Episode
Reporting Examples
Unique Scenarios that resulted in FAQ clarifications (1x visit, same therapy with multiple POC’s, same treatment date different disciplines treating etc.)
Claim Requirements
Out of Sequence Billing Issues
Transition from Test to Full Reporting July 1st, 2013
Functional Codes – Listed
Remittance Message Codes to expect
Other Resource Links
If you have started your own small library of education for your staff, don’t miss this newest addition to add to your collection.

Accounting and therapy departments alike are starting the nightmare of sorting out bills. Most specifically when the patient believed to be an inpatient stay that turned an ‘observation’ part B billing scenario, it creates specific challenges to attach outcomes coding in retrospect. Many inpatient departments are adding the step of applying codes just in case. If the patient leaves the observation status and becomes a ‘legitimate’ OP therapy patient, then the codes for the same impairment are expected to be carried over for up to 60 days. A re-evaluation may be in order but essentially the initial evaluation of that observation stay could be the same condition being treated in the outpatient encounter. You can see where this blurs the lines of accounting episodes of care and account numbers assigned. How are you handling these types of episodes and have you realized that the number of observation patients that you believed to be relatively few are actually a much larger percentage of the population you treat? The occasional encounter has been found to be a daily encounter most often and the ability to re-bill denied inpatient stays as part B has opened an entirely new set of strategic challenges especially when this could occur up to one year later and your outpatient therapy care occurred in between.

Jot your newly discovered challenges in the comment box below and if you have figured out a clever work flow or operational words of wisdom, leave them here too!

Share your CBOR experiences! How have G-codes and functional modifiers changed your hospital? Are you experiencing more denials? Are your therapists losing more time to documentation? Complete this brief survey on how G-codes are changing the way you practice and get paid.

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