Advice on keeping up with C-codes
C-codes, HCPCS, APCs, OPPS, IPPS—OR business managers need to master an intricate and sometimes mysterious set of Medicare regulations in charging for surgical services. In this column, Keith Siddel, MBA, an expert on health care business operations, responds to questions posed by members of OR Manager's OR Business Management Listserv.…
Self-administered drugs (SAD): Who pays?
There are certain drugs Medicare will not reimburse your facility for— even if they are given to a patient during surgery. These medications fall in the confusing category of self-administered drugs, or SAD. It's wise to know your organization's policy on SAD. If the policy is to bill patients for…
Avoiding inpatient-only claims pitfalls
Understanding how Medicare pays for inpatient and outpatient surgery is critical to your hospital's revenue. Medicare stipulates that certain procedures will be paid only if performed on an inpatient basis. How can you avoid pitfalls of billing for these inpatient-only procedures? OR Manager asked Keith Siddel, MBA, an expert on…
Six hospitals settle with feds over Medicare claims for kyphoplasty
Six hospitals in Indiana and Alabama agreed to pay the government more than $8 million to settle allegations that they submitted false claims to Medicare, the US Department of Justice announced September 29, 2009. The settlements resolve allegations that from 2002 to 2008, the hospitals overbilled Medicare for kyphoplasty, a…
Never events': Sorting out confusion
There's a lot of discussion about Medicare no longer paying for "never events." Surprisingly, so far, the policy has had little financial impact. Until recently, Medicare hadn't given instructions about how claims for these events should be handled. There is also confusion about how Medicare defines a "never event" for…
Settlement on kyphoplasty billing
In the first settlement of a national investigation, HealthEast Care System agreed in May to pay the federal government $2.28 million to settle allegations that 3 of its hospitals overbilled Medicare for kyphoplasties. Some 100 hospitals are under investigation, according to the legal expert who represented HealthEast. The investigation is…
RACs: What is the OR's role in readiness?
After some delay, Medicare's program to have outside companies audit claims is getting underway. The companies, called recovery audit contractors (RACs), will be checking to see that claims filed by hospitals, physicians, and other providers follow Medicare policies and procedures. OR Manager asked Keith Siddel, MBA, an expert on health…
Joint Commission aligning with CoPs
After a 15-year absence, language on the RN circulator in the OR could be back in the Joint Commission hospital accreditation standards. It's one of the changes the Joint Commission is making to bring its requirements in line with the Medicare Conditions of Participation (CoPs). The changes, posted Jan 5,…
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