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March 2 Issue:
Process Mapping and the Revenue Cycle
Having problems receiving proper reimbursement for ambulatory services? By analyzing the process in great detail, you just may find the answer.
Telemedicine: Miles Don’t Matter
No longer an anomaly, various forms of connected health, including remote monitoring, are reshaping ideas on how providers can give consumers quality, convenient care.
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In these shaky economic times, everyone’s looking to gain a little extra financial edge. What if physician practices could produce accurate bills and be paid before the patient leaves the office? This month’s E-News Exclusive examines that possibility. |
| E-News Exclusive |
 Getting Real About Real-Time Adjudication
By Kendra Obrist
As with any business, the current economic climate has taken its toll on physician practices, as many find reimbursements decreasing while accounts receivables increase. This is especially true within the small, one- to five-provider offices that employ the majority of U.S. clinicians. More troubling, reimbursements will likely fall more. In a recent survey by The Physicians’ Foundation, 82% of physicians said their practices would be unsustainable if proposed cuts to Medicare reimbursement were approved. At the same time, increased health insurance costs have brought about the emergence of the patient as the payer. Today, self-pay, in which a patient is responsible to pay for the care he or she receives, represents a significant portion of the provider’s total billings.
McKinsey & Company estimates that patient pay will account for 35% of provider revenue by 2010. This shift represents a major business challenge for physicians, since historically practices collect less than 25 cents of every self-pay dollar. To sustain their practices and provide patients with quality care, physicians and practice managers need to develop a strategy to increase self-pay collections.
(FULL STORY) |
| Industry Insight |
The Joint Commission to Include Patient Satisfaction Data on Site
People seeking information about how patients perceive the care they received at a particular hospital can now find this information on The Joint Commission’s Quality Check Web site at www.qualitycheck.org.
The Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) data from the Centers for Medicare & Medicaid Services’ (CMS) Hospital Compare Web site is now posted on Quality Check and will be updated quarterly.
(READ MORE) |
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| Ask the Expert |
Have a coding or transcription question? Get an expert answer by sending an e-mail to edit@gvpub.com.
This month’s selection:
Is there a specific CPT code for an MRI of sacrum/coccyx? If not, would 76498 for an unlisted MRI procedure be appropriate?
Jolyn B. Tyson, RN, BSN, CHCQM, FAIHQ
Revenue integrity auditor
Lakeland Regional Medical Center
Lakeland, Fla.
Response:
This is how pelvis is defined in Dorland’s Medical Dictionary:
The inferior portion of the trunk of the body, bounded anteriorly and laterally by the two hip bones and posteriorly by the sacrum and coccyx. The pelvis is divided by a plane passing through the terminal lines into the p. major superiorly and the p. minor inferiorly. The superior boundary of the pelvic cavity is the inlet (apertura pelvis superior [TA]), and the inferior boundary of the pelvis minor is the outlet (apertura pelvis inferior [TA]), which is bounded by the coccyx, the symphysis pubis, and the ischium of either side. The outlet is closed by the coccygeus and levator ani muscles and the perineal fascia, which form the floor of the pelvis.
For further reference, the 3M codefinder gives "sacrum" as an example when doing a search for MRI of the pelvis.
Since MRI of the pelvis includes the sacrum and coccyx, I’d say that 76498 is not appropriate.
72195 MRI imaging, pelvis; without contrast material(s);
72196 MRI imaging, pelvis; with contrast material(s);
72197 MRI imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences;
If the provider additionally uses 3D rendering, interpretation, and reporting, requiring image postprocessing on an independent workstation, add 76377 as an additional code, or add 76376 instead if the 3D rendering, etc is without the need for the independent workstation.
— Judy Sturgeon, CCS, is the hospital coding senior manager at The University of Texas Medical Branch in Galveston and a contributing editor at For The Record. While her initial education was in medical technology, she has been in hospital coding and appeal management for 20 years.
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