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Reimbursement Unit

Andrew Ozmun

Out-Patient Hospital Resources

For questions, contact
Andrew Ozmun
801-538-6733



24-hour Rule Designating Inpatient and Outpatient

Result of 24-hour rule hearing: Policy Committee voted to remove the 24-hour rule. This change received approval.  Public Notice, SPA and other documentation are being worked on.  This change will be effective at the same time as the Outpatient conversion go-live date. The programming will be end-date-of-service specific

 

Outpatient Resources:

Overview:    Outpatient presentation 5/19/2011

List of questions & answers from billers 2011-09-12

CMS Links

CMS Addendum:  Click "accept" at the bottom, then save to your computer.  Be sure to view addendum B (List of Procedure codes & Medicare Reimbursement) &  addendum D1 (description of status indicators). 

CMS Download web page. (CMS updates quarterly)

CMS Provider file: Includes CCR value for hospitals (CMS updates quarterly)

Medicare outpatient manual "Chapter 4"

Medicaid Coverage

Utah Hospital list: Indicating OPPS & CAH facilities

Revenue Code Traditional & Nontrad plan coverage: Medicare and Medicaid

Medicaid Claim Flow Chart

Resolution Tracking

Lab Panel Payment Letter

Lab Panel and Other Payments Clarification Letter

 

Fee Schedules

2014

October 1, 2014

July 1, 2014

April 1, 2014

January 1, 2014

2013

October 1, 2013

July 1, 2013

April 1, 2013

January 1, 2013

2012

October 1, 2012

July 1, 2012

April 1, 2012

January 1, 2012

2011

December 1, 2011

November 1, 2011

October 1, 2011

September 1, 2011

 

What Edits Will be Used?

 

Edit Abbreviations

NCCI

 Part of OCE editor (Edits #19, 20, 39, 40)

http://www.cms.gov/OutpatientCodeEdit/

MUE

 Part of OCE editor: (edit #15) Bloodhound (3rd party vendor) applies them

http://www.cms.gov/MedicaidNCCICoding/06_

NCCIandMUEEdits.asp

NCD

Not used

 

LCD

Not used

CCI

(Physician & outpatient)

 

  

Last edited December 1, 2011