Reimbursement:
MASTER THESE NEW PPS CODES
Published on Mon Oct 01, 2007
Put new focus on revamped OASIS matching string.
To get a handle on billing under the coming PPS refinements, you need to understand the differences in the three billing-related codes. • HHRGs. Accurate billing will depend on knowing what the prospective payment system claims-related codes represent, said consultant M. Aaron Little in an Oct. 24 Eli-sponsored audioconference on the billing changes. The HHRG codes will be the least changed under the PPS refinements, noted Little with BKD in Springfield, MO.
The codes CxFxSx will continue to represent the severity level of each dimension--Clinical, Functional and Service. Because the number of severity levels in each dimension has changed, the lowest code now will be C1F1S1 and the highest code will be C3F3S5. Under the current system, the lowest code is C0F0S0 and the highest is C3F4S3. • HIPPS codes. The Centers for Medicare & Medicaid Services has given the HIPPS billing codes a major revamp under the PPS refinements. The first digit of the 1,836 new codes will represent the grouping step and the last digit will represent the NRS level (see Eli's HCW, Vol. XVI, No. 36 for a complete code breakdown). Digits 2 through 4 will continue to represent the Clinical, Functional and Service domains, but they will do so with letters that correspond to the severity level instead of the current numbers.
Must: Billers must become very familiar with the new codes. For example, staff should know at a glance that when a letter is in the fifth digit of the HIPPS code, it means the agency furnished and billed Nonroutine Supplies. If it's a number, the agency didn't furnish and bill NRS. • OASIS matching string. Up to now, billers have been able to ignore the OASIS matching key with little reimbursement fallout. But that will change when the refinements hit Jan. 1. This code is vitally important because it gives the Medicare claims system the information to recode your claim if it must be regrouped--for example, if the episode sequence is different than the one included on the RAP or if therapy utilization is different than originally stated.
Pay attention: The string "is going to have a potential impact on your payment," Little told attendees. "This OASIS matching string is going to be how Medicare knows if they have to change the payment groupings."
In an obscure representation system, the 18-digit string will include information on start of care and assessment dates; reason for assessment; early or late episode status; and clinical and functional levels for all four equations (see Eli's HCW, Vol. XVI, No. 36 for a code breakdown by digit).
That means billers will have to focus on this code's accuracy, Little advised. "It is critical that this OASIS matching [...]
