This page is provided by the Medicare Learning Network as a guide to the resources available on the HCFA home page. This page is constantly updated, so check back often. HCFA will be working with the American Hospital Association and the American Medical Association to propose the establishment of appropriate facility-based patient visit codes. In the meantime, this will be a difficult area to review for correct coding. Additionally, medical review can determine if the hospital is billing according to its established procedures.
Observation is a major problem.
Yes, any service packaged or not, may be subject to review. If the observation services are not reasonable and necessary, they should still be denied. All claims will go through the OCE again after medical review. Denial of observation room charges will affect outlier and transitional corridor payments, as well as future APC rates. If a line item is denied on a partial hospitalization claim, but the PHP day of service is approved, the provider will receive PHP per diem APC reimbursement.