10 tips for avoiding APC traps.
To encourage proper payment and avoid imposition of penalties by the Office of Inspector General, providers need to prioritize outpatient compliance efforts. Departments should be accountable for reconciling outpatient code editor edit failures. Evaluation and management code assignment should be examined for inter-rater reliability. Transitional pass-through items should be audited routinely; associated coding should be kept current. Consideration should be given to meeting medical necessity requirements, particularly for mental health services.
Micheletti
Julie A
JA
HSS, Inc., Hamden, Connecticut, USA. jmich@hss-info.com
Berger
Steven
S
Grujanac
Louis
L
D000553:Ambulatory Care / Q000145:classification* / Q000191:economics; D014487:Centers for Medicare and Medicaid Services, U.S.; D003953:Diagnosis-Related Groups / Q000145:classification; D004282:Documentation; D005377:Financial Management, Hospital / Q000592:standards*; D005568:Forms and Records Control / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D007344:Insurance Claim Reporting / Q000592:standards*; D008484:Medicaid; D006278:Medicare; D020380:Needs Assessment; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D015203:Reproducibility of Results; D014481:United States