Medlearn Media NPOS Non-patient outcome spending

Check your coding year-end checklist twice.

As focus shifts to the end of year, there are many tasks to complete to ensure accurate billing and coding. Here is a checklist that I have created.

  1. Verify that MS-DRGs v40 New Technology Add-On Payment items are being coded. Run a frequency list for these items and compare with the Pharmacy, Operating Room, and Central Stores numbers. A list of the ICD-10-PCS codes can be found on the CMS website under FY2023 Final Rule Inpatient Prospective Payment System (IPPS) – MAC Implementation File #8.
  2. Review the list of New Technology Add-On Payment (NTAP) items and determine which items are utilized at your facility. These items add additional monies to the MS-DRG reimbursement, so it is important to check multiple times during the year to ensure that all the NTAP items being used at your facility are being captured.
  3. Begin to look for your external coding auditor. Identify the parameters for your coding review. The coding review should be completed by the end of February 2023. The goal of this coding review is to ensure the new ICD-10-CM/PCS codes are being assigned appropriately. Another goal may be to check accuracy of coding staff. It is important to compare multiple quotes.
  4. Continue provider education on the new evaluation and management (E&M) guidelines. Ensure that providers will be ready for Jan. 1. Plan remedial education sessions for January. Provide a contact for any questions of assignment of E&M codes.
  5. New CY23 CPT® codes should be added into the chargemaster for implementation. Explore possibilities of including ICD-10-PCS codes in the chargemaster or formulary. This option eliminates the need for health information management coders to assign codes for implants or medications which they do not usually do. It is also a time to identify line items that are no longer used. Determine if the line items should be carried to the next calendar year. The updated chargemaster will be activated for Jan. 1 services/visits.
  6. Update your facility-specific coding guidelines if they have not been updated since Oct. 1. The guidelines will require another update for the CY23 CPT codes. This document is valuable to the coding and auditing staffs and promotes consistency.
  7. Update the price transparency files with updated CPT/HCPCS files for CY 23. This update assists in being compliant with the price transparency rules.
  8. Verify that the additional monies for the COVID cases are being received. This task would involve the billing staff. Remember that the additional monies will continue until the end of the fiscal year when the end of the public health emergency is declared over. If the declaration is made before Sept. 30, 2023, then the additional monies will be received until that date.

The year end is a busy time for healthcare workers and providers. It is best to start these tasks early as it is holiday time. Remember that Santa Claus is checking his list twice!

Happy Holidays to everyone!

Resources:

New Technology Add-On Payment: https://www.cms.gov/medicare/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page

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