Healthcare is advancing and evolving to value-based patient care, and clinical and business trends are showing increases in physicians providing services under the umbrella of larger facilities and hospital healthcare organizations. Facility inpatient and outpatient care and reimbursement have become the up-and-coming area that healthcare business professionals are focusing on. There are coder and clinical staff shortages reported by many facilities, so it makes sense to better understand this fast-growing area of healthcare.
Outpatient coding reimbursement is based on the physician fee schedule, insurance contracted rates, ambulatory surgical center rates, and CPT®, ICD-10, and HCPCS Level II code assignments; while inpatient reimbursement is mostly based on ICD-10-PCS and the diagnosis-related group (DRG) code assignments. To bill for inpatient services, you must determine the principal diagnosis (the reason for the admission) to assign the correct DRG to the inpatient stay. Factors that may influence the DRG are major complication/comorbidity (MCC), complication/comorbidity (CC), and the type surgery.
As facility coding becomes more prevalent in healthcare, let this webpage be your go-to place for news and information about the business side of inpatient and outpatient care.