Outpatient care has become a cornerstone of modern healthcare, thanks to technological advancements, patient preferences, and cost-effective treatment models. As outpatient services expand, so do the administrative and financial complexities behind the scenes. Revenue Cycle Management (RCM) for outpatient care is no small feat — it involves managing patient scheduling, insurance verification, coding, billing, and […]
Observation, outpatient outlier payments, and the Inpatient-only List: Getting it right is not always easy. On this week’s Monitor Mondays we had a robust discussion about Condition Code 44. And on June 9, I will be presenting a webinar on the nebulous concept of “outpatient” service in a bed. Both of these have one thing […]
Please be mindful that several coding and billing alterations pertaining to outpatient claims have been backdated to either April or January. Numerous modifications to Medicare’s Outpatient Prospective Payment System (OPPS) in the July update closely mirror those in the Medicare Physician Fee Schedule Database (MPFSDB) update for the same quarter. These include the introduction of […]
CMS has announced that it will reprocess hospital outpatient claims from last year for clinic visit services provided at excepted off-campus provider-based departments. The agency will start reprocessing the claims in July 2021 in order to pay all hospitals the same rate as non-excepted off-campus provider-based departments for clinic visit services paid under the Physician Fee Schedule, […]




