Maximize revenue while avoiding risky practices with this unique resource as your guide
Facilities are looking to maximize revenue, but, with respiratory therapy services, it’s also about avoiding risky practices — because auditors, regulators, and payers are paying attention! This unique resource will guide you through charge capture and coding while helping you avoid noncompliant practices for a full range of respiratory therapy, pulmonary function testing, and sleep study services.
Count on our trusted experts to guide you step by step through the intricacies of coding, charging, billing and documentation for this very challenging area of healthcare. Along the way, you’ll discover a wealth of dos and don’ts, equipping you to protect your compliance and revenue. For 2020, we address many potential pitfalls, including insufficient documentation, unbundled coding, modifier misuse and the inappropriate coding of services.
Overcome your obstacles. Don’t let outdated or incomplete information sabotage your compliance. Join the numerous professionals across the country that have embraced our resource for a full range of RT/pulmonary function compliance solutions.
Features and Benefits
Updated and expanded content for 2020, including:
- Explanations and practical application of revised codes for airway resistance and electroencephalogram (EEG) procedures used during sleep studies
- Guidance with all RT-specific HCPCS code changes and NCCI updates
- Comprehensive information about pulmonary rehab, now an approved RAC audit topic, that poses serious consequences for noncompliance
- Updated billing tips, expanded guidance and real-life case examples pertaining to inhalation treatments, including coding guidelines and clarification of confusing NCCI rules
- Expanded information and new guidance specific to inhaled nitric oxide, pulmonary rehab, and respiratory rehab
- New FAQ section addressing some of the most commonly asked questions and challenges observed by our experts across the country
- Special guidance with services that should not be reported, such as E&M and recreational therapy; this is a growing area of noncompliance for RT departments that focus on counting productivity
Our experts address common questions, concerns, and problem areas:
- High-risk practices inherent with polysomnography and other sleep studies, such as insufficient prior authorization and incorrect coding for home sleep study tests
- Billing issues with breathing treatments — a prime RAC target — and billing sequence or date of service
- Unbundling of codes and groups of CPT/HCPCS codes that are inappropriately reported together
- Incorrectly billing for routine monitoring, oxygen, and services not specifically ordered by a physician
- Medicare medical necessity coverage policies and frequency limitations
- Lack of documentation to support medical necessity
Clear, step-by-step guidance through the tasks you perform every day:
- Coding, documentation, and billing for a full range of respiratory therapy services and pulmonary function testing, plus polysomnography and other sleep studies, home sleep testing and penile studies
- Covers code assignments by both hospital (technical) and physician (professional) entities
A proven quick-reference approach for busy professionals:
- Easy to navigate; each section contains:
- Descriptions and intended uses of services provided
- Listings of the corresponding CPT/HCPCS and revenue codes, along with explanations of intended code usage
- Modifier usage, where appropriate
- Documentation and medical necessity requirements
- Billing tips
- Clinical examples
- Complete and current payment information, including:
- Hospital OPPS rates
- Procedures with APCs, status indicators and at-a-glance tables showing CPT/HCPCS codes included in APCs, plus prior year and current payment rates
- National and local coverage determinations (LCDs/NCDs)
- Advance beneficiary notices (ABNs)
- National Correct Coding Initiative (NCCI) edits
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