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Medicare coverage of intestinal transplants for beneficiaries with irreversible intestinal failure began April 1, with the implementation of a National Coverage Decision by the Health Care Financing Administration in Baltimore. These procedures will be available at three transplant centers recently approved by Medicare: the University of Pittsburgh Medical Center, the Jackson Memorial Hospital Transplant Center in Miami, and The Mt. Sinai Hospital in New York. The procedure will benefit the relatively few Medicare beneficiaries whose intestines are unable to absorb nutrients.
Intestinal transplantation is a relatively new technology that has been pioneered in this country primarily at the University of Pittsburgh School of Medicine. Fewer than 1,000 transplants have been performed in the United States, with approximately two-thirds of the patients being children.
The American Health Information Management Association (AHIMA) in Chicago has joined with 3M Health Information Systems in Salt Lake City to offer web-based continuing education (CE) training for understanding and successfully navigating the outpatient prospective payment system (OPPS) environment and ambulatory payment classifications (APCs). The curriculum includes:
• APC Basics (8 CE credits).
This course provides the information needed to understand the impact of the OPPS on health care organizations. It includes an overview of APCs and addresses the topics of data required for APC assignment, chargemaster maintenance and billing, and charging accuracy.
• APC Coding and Documentation Issues (12 CE credits).
This course reviews how the accuracy of outpatient coding affects APC reimbursement and discusses ways to improve critical outpatient coding. It also includes lessons on HIM operations related to APC implementation, HCPCS coding, evaluation and management coding, and the use of modifiers.
• Outpatient Code Editor (OCE) Essentials (5 CE credits).
This course outlines information on billing and reimbursement issues related to the APCs so health care organizations can maintain cash flow and minimize claims rejections and denials. Topics covered include OCE edit categories including National Correct Coding Initiative (NCCI) edits, denial management, and operational issues.
Health information management professionals can access APC courses through AHIMA’s Continuing Education Interactive Learning Campus. Courses can be bought separately for $250 each or all three for $650. To register for APC courses or to find out about other AHIMA on-line courses, visit www.ahimacampus.org. For a free demonstration of the program, visit www.ahimacampus.org/demos.
Witnesses at a House of Representatives hearing in April said a lack of regulatory education and the private companies who process Health Care Financing Administration (HCFA) Medicare billing and payments are to blame for errors in compliance and billing, reports the American Hospital Association (AHA) News.
At Medicare’s inception in 1965, providers were given authority to name payment intermediaries. Michael Mangano, acting inspector general for the Department of Health and Human Services, said that authority should belong to HCFA so the organization could better monitor the private contractors who file payments and billing to providers of Medicare services, the AHA says.
Committee members echoed remarks by Health and Human Services Secretary Tommy Thompson to the effect that HCFA reform should include modifications in private contractor selection. Other errors were attributed to the vast and complex Medicare regulatory policies, which cause many doctors to drop out of the program for fear of penalties for honest mistakes. However, HCFA representative Mark Miller said payment errors have been cut in half since 1996 and the administration is involved in a comprehensive outreach program to educate providers. For more information on the hearing, visit the House Energy and Commerce Committee web site at www.house.gov/commerce/.
Johns Hopkins Medicine in Baltimore has launched a peer-reviewed database and point of care decision-support system designed to give hospital- and office-based physicians free updated information on antibiotics and their proper use.
The Antibiotic Guide (ABX Guide) is the first in a planned series of regularly updated digital medical handbooks from Hopkins specialists. The guide works on the web (hopkins-abxguide.org) and personal digital assistants (PDAs), such as the Microsoft PocketPC.
The guide offers information on more than 160 drugs and more than 140 diseases treated by both specialists and primary care physicians. Emergency alerts, such as Food and Drug Administration recalls, can be "pushed" to all users in an instant, assuming physicians access the updated database regularly.
Development of the ABX Guide was funded by unrestricted educational grants to Hopkins POC-IT from various sponsors. Sponsors are acknowledged in a special section on the web site, but no banner or commercial advertising exists in any of the applications.