Hospital Outpatient Infusion Services: 2020 Reimbursement & Compliance Update

Protect high-volume payments from high-risk practices

Nearly every patient who enters your hospital receives an infusion or injection of some kind. Which leads to important questions: What’s the compliance risk if documentation isn’t fully supportive of the charges for infusions and injections? What’s the impact of missed revenue opportunities due to coding mistakes and omissions repeated over a large volume of patients? The answers might shock you.

2019 saw a host of compliance issues with recovery audit contractors (RACs) targeting infusions and injections, paying special attention to code assignments lacking sufficient documentation. In 2019 claims for hydration therapy and drug administration were under review, and the scrutiny is likely to intensify in 2020.

By attending this annual update webcast, you can start the year with a clear understanding of the threats to your compliance and payments, as well as the steps you need to take to mitigate risks from the start. Don’t let outdated or incomplete information sabotage your compliance. Through in-depth explanations, case examples and visual aids, our expert presenters will show you the way to fully compliant coding, billing and documentation requirements in all care settings.

Webcast Takeaways

• A review of key changes, trends and compliance risks for 2020, including:
  • The risks inherent with hydration therapy, drug administration, and other audit targets
  • Commercial payer trends, including discussion of "brown bagging" vs. "white bagging” drug supplies
  • What Medicare, MACs and private payers are saying about documentation for drug administration charges
  • Changes to APC payment methodologies under the Hospital Outpatient Prospective Payment System (HOPPS)
• What documentation is required to support outpatient injection and infusion codes, plus help with common EHR documentation challenges
• A close look at the physician order and nursing documentation; includes a quick-reference procedure chart to help identify essential elements, including start and stop times
• Identifying and mitigating the potential risks associated with charges for prolonged infusions
• How to communicate with nursing staff about the importance of complete, high-quality documentation
• Guidance with properly documenting time increments for infusion services; includes answers to questions such as: “If a patient is receiving an IV infusion for hydration therapy and the stop time is not documented in the medical record, how should the service be coded?”
• How to handle the initial hour of infusion, additional hours of infusion and infusions over the midnight hour
• Avoiding hydration therapy pitfalls related to documentation, medical necessity, indications, limitations and more; includes clinical examples and links to additional background from Noridian, Medicare, the AMA, and other sources
• Conducting internal audits — tips for process improvements
• Time permitting, answers to attendee questions