Avoid the common mistakes that cost you revenue and regulatory compliance
Under-reporting units for radiopharmaceuticals. Missing codes for common procedures. Unbundled billing. Mistakes like these occur all too often in the hospitals, clinics and imaging centers where nuclear medicine procedures are performed. In many cases, staff simply do not understand the rules. Count on MedLearn's Nuclear Medicine & PET Coder book to help you navigate with confidence through this very complex area of medicine. Highlights:
- 2011 final Medicare payment policy for nuclear medicine and PET procedures
- New and revised 2011 CPT codes and modifiers
- Current Medicare rates, including APC categories, national HOPPS payment rate and physician fee schedule
- Current RVUs for professional, technical and global components, accompanied by their corresponding national payment rates
- Radiopharmaceutical code list, along with drug tables and crosswalks to common material names
- Coding and billing tips, grouped by body section
- Separate PET section, including an at-a-glance table showing what's covered and what's not
- NEW FOR 2011:
- Explanations of new modifiers, including KX for PET studies
- New guidance with billing for sodium fluoride PET imaging
- Updated therapy section, including new tips and explanations of radioimmunotherapy (RIT) codes
- Review of key 2011 rule changes pertaining to the Medicare physician fee schedule and HOPPS
- New payment tables and RIT code table
Findings from MedLearn consulting experts
MedLearn consulting experts speak from their real-world experiences regarding the potential benefits of Nuclear Medicine & PET Coder to healthcare organizations:
A high-risk area for RAC action - "As the Recovery Audit Contractor (RAC) program continues its nationwide rollout, we see nuclear medicine and PET studies as being vulnerable to scrutiny, particularly with the packaging of services and bundling of codes. It's imperative for providers to make sure their coders understand and consistently follow the new rules."
The cost of charging errors - "Facilities and practices continue to charge incorrectly for lung scans, because they don't differentiate between gas and aerosol methods. The difference in physician payment can range from approximately $25 to $60 per procedure. In addition, providers often forget to add cardiology charges, which can mean another $20 to $30 in lost payment. The appropriate coding and billing guidelines for lung scans are spelled out in our book.”
A common mistake, multiplied - "A recent audit in a hospital revealed systematic undercharging for a common radiopharmaceutical. The cause? Staff members were charging for one unit when they should have been charging for four, because they misinterpreted a code description in the chargemaster. Multiplied over the course of a year, this mistake was resulting in a substantial amount of lost revenue - entirely preventable by knowing and following established processes."
Missing RP charges - "Nuclear Medicine & PET Coder makes it clear that the CMS requires a radiopharmaceutical charge on a claim for any hospital-based nuclear medicine procedure, or the claim will be rejected. Nevertheless, we still see missing RP charges. For a procedure code (78xxx series), the lost or delayed reimbursement can range from about $100 to more than $1,400 under the APC payment methodology."
CPT is a registered trademark of the American Medical Association
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