Method II billing


Rutland, VT
Best answers
I am going to start my question with a disclaimer that I am a coder, not a biller, so if any of my language regarding claims is incorrect, please forgive me.

I'm in an interesting situation right now where my organization (CAH) is about to go live with a new EMR. This is a huge project, and we have a major question with part of the build. For our Medicare patients, anyone admitted from an outpatient department to an inpatient department (such as ED to Inpatient) needs to have the account split and have the outpatient and inpatient portions billed on different claim types. For the new EMR we can either have this done prior to coding or after. Prior to coding presents a lot of different challenges that I won't get into, so the goal is to have the account split after coding. However, the system will automatically use the same diagnoses on both portions. This would of course be incorrect by coding guidelines, as there could be suspected diagnoses, etc, that should not be on the outpatient portion. HOWEVER, is there any exception to this rule that CMS has stated? If we were not CAH, the account would go out on one claim type, and all those diagnoses would still be there. We are trying to a) avoid splitting the account prior to coding and b) avoid manually re-reviewing the outpatient account to remove any inpatient diagnoses.

Any advice or resources I can review? I believe so strongly in this, and am coming up really short finding the answer. Frankly, my knowledge of the billing side of the house is limited, but I am part of this build and do understand the basics!

Thanks in advance!