Reimbursement Insights for Offices and Outpatient Departments

Reimbursement keeps physician and/or qualified healthcare professional (QHP) offices and hospital owned outpatient provider-based departments (PBDs) humming along. By attending my SAWC Spring session, attendees will receive some important coverage, coding, and payment insights to aid in their reimbursement.

Because reimbursement begins with documentation and coverage, you will be encouraged to understand how your electronic health record (EHR) system functions and to read the documentation it provides.

To support accurate coding, offices and PBDs will be reminded about the importance of obtaining and following current coding books and guidelines. Because many physicians/QHPs have not yet implemented the new evaluation and management (E/M) coding guidelines for office and outpatient visits, I will enumerate them in my presentation.

Because physicians, QHPs, and PBDs continue to receive denials and audits pertaining to coding for debridement and the application of cellular and/or tissue-based product for skin wounds (CTPs), I will provide explicit coding directions for these procedures and a few special directions from some Medicare Administrative Contractors (MACs).

Because telehealth has become an important tool during the COVID-19 public health emergency (PHE), it is prudent to prepare for offering similar digital services when the COVID-19 PHE telehealth waivers end. Therefore, I will discuss several alternatives to telehealth e.g., communication technology-based services (CTBS) and remote physiologic monitoring (RPM).

My presentation also reviews various payment insights for services such as hyperbaric oxygen therapy (HBOT), application of new disposable negative pressure wound therapy (dNPWT) pumps, and application of CTPs in physician offices.  

And last, but not least, audit penalties and fines can be avoided by conducting internal audits. My presentation reviews how to implement an internal audit process, goes over possible topics for internal audits, and emphasizes the importance of responding to additional documentation requests (ADR).

To watch “Reimbursement Insights for Offices and Outpatient Departments,” click here.