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- The hospital bill for laboratory services only after they are performed
- The hospital bill only for medically necessary services
- The hospital bill only for tests actually ordered by a physician and provided by the hospital laboratory
- The current procedural terminology or Healthcare Common Procedural Coding System code used by the billing staff accurately describes the service ordered
- The coding staff submit only diagnostic information obtained from qualified personnel and contact the appropriate personnel to obtain diagnostic information in the event that the individual who ordered the test has failed to provide such information
- The hospital document receipt of diagnostic information obtained from a physician or the physician’s staff after receiving the specimen and request for services
- Routine audits be conducted to assess your billing compliance with the regulations
The next Hospital & Hospital Quality Open Door Forum is scheduled for 2 p.m. Eastern, Thursday, November 19. To access the call, 800/837-1935 and reference conference ID: 34708559.
A transcript and audio recording of the conference call will be available to MedicareFind subscribers approximately one week after the Open Door Forum is held.
By Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc.
Last week, I participated in an HCPro audioconference on HINNs. "HINN" stands for hospital-issued notice of non-coverage. It’s the inpatient equivalent of an advanced beneficiary notice (ABN). Under Medicare’s limitation on liability (LOL) provisions, hospitals are required to provide prior notice, in a prescribed form, when certain outpatient or inpatient services ordered by a physician do not meet Medicare’s medical necessity guidelines for the patient’s condition.
In such cases, the ABN is the prescribed form of prior notice for outpatient services, while the HINN is the prescribed from of prior notice for inpatient services. Although the prior notice requirements for LOL have been in place for a number of years, hospitals continue to struggle to provide timely, appropriate notification, particularly in the inpatient setting.
A recent statement from U.S. Health and Human Services Secretary Kathleen Sebelius seems innocuous enough—many people seeking care in emergency departments are uninsured.
The nation's leading group of emergency physicians immediately took issue with her remarks, however. They chastised her for perpetuating a myth about hospital care and said she is oblivious to a much bigger problem.
In her statement, Sebelius cited statistics from a database managed by the Agency for Health Research and Quality. These statistics reveal that in 2006:
- One in 5 patients seen in emergency department settings was uninsured,
- Low-income patients accounted for almost one-third of patient visits,
- Residents of rural areas comprised one-fifth of emergency room care
Sebelius observed that uninsured patients often cannot afford primary care and must seek care in the ED. ED physicians, including Nick Jouriles, MD, president of the American College of Emergency Physicians, say this statement helps direct resources to managed care instead of emergency departments where they are most needed.
Source: HealthLeaders Media
The next Hospital & Hospital Quality Open Door Forum (ODF) conference call is scheduled for Thursday, July 16, at 2 p.m. Eastern. To access the call, dial 800-837-1935 and reference conference ID 16862069.
CMS has set the date of the next Hospital & Hospital Quality Open Door Forum (ODF) conference call to Thursday, July 16, at 2 p.m. Eastern. To access the call, dial 800-837-1935 and reference conference ID 16862069.
Subscribe to MedicareFind to access transcripts and audio of previous ODF calls.
In an effort to reform healthcare and reduce costs, President Obama has called for $313 billion in healthcare spending cuts.
The proposed cuts include a $220 billion reduction in hospital payments over the next 10 years. The American Hospital Association (AHA) expressed deep disappointment and noted that hospitals already face a previously announced potential $38 billion cut and $41 billion in cuts under the proposed Medicare Inpatient Prospective Payment System rule.
AHA President and CEO, Rich Umbdenstock said, “Reform must improve care for patients without crippling hospitals’ ability to care for patients and communities.”
Source: AHA News Now
Although the next Hospital Open Door Forum was previously scheduled for June 25, CMS has confirmed that the call will be rescheduled to mid-July.
If you're looking for Hospital Open Door Forum resources, transcripts and audio recordings of past Open Door Forum conference calls are available through MedicareFind.
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