detail tabs Flashcards
Guidelines
there is a plus and minus sign, will expand and collapse the information in section.
expand to show guidelines details close to show different sections
Revision History
CMS revises descriptions 4 times a year. this tab shows revision history.
newest revision on top and we stack it so we can see what changed. long and medium and short all display
APC info ( say the word not in abbreviated form)
medicare ambulatory payment classification if there are more than one entity, they would need to be on the correct entity to see accurate APC info.
most current apc adj on top.
composite complexity adjustment
when a single payment rate for a service which is a combination of several HCPCS codes on the same date of service (or a different date) for several major procedures.
ASC Info ( name this abbreviation)
Ambulatory Surgery Center
discuses the columns
Rev Codes
codes used on hospital bills to tell the insurance companies where the patient was when they received treatment
Best practices - provides list of rev codes vitalware determined are most suitable for code selected.
what does rev code Medicare outpatient provide:
provides the rev code bill count how many times that rev code was billed with the CPT/HCPCS based on the SAF data
total cpt/hcpcs billed count - rep the total number of times a cpt/hcpcs code being reviewed was billed
percent rev code - percent of times that rev code billed with the cpt
CCI (PTP) Facility( what is the abbreviation)
Correct Coding initiative/Procedure to Procedure
column 1 -shows the payable code
column 2 contains the code that is not payable with this column 1 code, unless a mod is permitted.
Modifiers
service or procedure performed has been altered by some specific circumstance. used to add info or change the description of service.
Fac SAF Analytics ( abbreviation
facility standard analytical file
display statistics about the code selected in relation to its use in the facility setting.
detailed claims info about health care services to medicare beneficiaries in the outpatient setting.
aggregated from most recent four quarters of data available for cms and updated quarterly basis.
LCD/Articles( abbreviation)
Local Coverage Determination
contains all local coverage determinations and articles for a particular contractor related to the code.
Transmittals
communicate new or changed policies or procedure that will be incorporated into the cms online manual system.
MUE
maximum of numbers of units of services per CPT code.
Pro MPFS
professional medicare physician fee schedule
the pro MPFS tab includes locality- specific payment info from the medicare physician fee schedule in relation to the selected code.
CDM code reference ( abbreviation)
Charge description master
Identifies if the searched code is in their CDM
