Reimbursement

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Resources on ICD-10

ICD-10-CM And The Emergency Physician Information Paper 
The October 1, 2015 implementation date for switching from ICD-9 to ICD-10 is fast approaching. You should be preparing now so your claims processing and revenue stream are not negatively impacted. The ACEP Coding and Nomenclature Advisory Committee (CNAC) has prepared an information paper to help explain the changes to make the transition easier. 

ICD-10-CM For The Busy Emergency Physician
This ICD-10-CM manual was created by ED physicians for ED physicians to help provide an easy to read, clinically based reference. 

ICD-10-CM ED Clinical Examples
The list of definitions for precise documentation of specific anatomical injury or illness.

Reimbursement Webinars Available from ACEP eCME
 Countdown to ICD-10
 Critical Care and Observation
 Industry Update
 Nuts and Bolts...Reimbursement Primer
 Nuts and Bolts...The Basics

Additional Reimbursement Resources and Information
ACEP/PAI TOOLKIT
The American College of Emergency Physicians (ACEP) has collaborated with the Physicians Advocacy Institute (PAI) to develop a Toolkit for Physicians Facing Medical Audits.  The Toolkit provides practical information and tips to guide physicians in anticipating medical audits, responding to auditors’ requests for medical records, and appealing erroneous audit findings. The Toolkit also includes detailed information regarding the various types of governmental and private payer audits, appellate procedures, and extrapolation methodologies used by some payers to calculate alleged overpayments.  The toolkit can be accessed at the following link:  
http://www.physiciansadvocacyinstitute.org/Advocacy/Fair-Medical-Audits/Toolkits-Resources      
     
Preparing for Payer Audits     
The American College of Emergency Physicians developed this document to provide its members basic guidance on preparing for payer audits. Due to differences in regional/state/and jurisdictional precepts, rules and regulations, legal guidance should be sought from a qualified attorney in the relevant locality as early in the payer audit process as possible.   

Why Higher Acuity of Emergency Medicine E/M Codes Condensed 
Over the past few years, the Centers for Medicare & Medicaid Services (CMS) has observed a shift of Evaluation and Management (E&M) codes in the Emergency Department (ED), prompting their concern for excessive payments by CMS to emergency physicians. The purpose of these papers is to inform practicing emergency physicians why this code shift has occurred. Unless otherwise noted, the points that follow are pertinent to Medicare.       

Impact of High Deductible Health Plans  

 Over the past several years there has been rapid growth in the portion of medical bills that is not covered by insurance, and that instead is the patient’s responsibility to pay directly. The amount that becomes the patient’s responsibility comes from three main categories: copays, co-insurance, and deductibles.   

Emergency Medicine and Payment Reform
Healthcare reform is introducing evolving methodologies for payment as opposed to the traditional fee for service model. Not all of the new payment methodologies work well in the ED setting. This paper from the ACEP Reimbursement Committee outlines the various options being discussed and the potential impact on the ED.   

Top 20 ED Codes
This chart lists the 20 most often services provided in the ED along with their 2015 Medicare RVU allocations.     

2015 Medicare RVU's By Each CPT Code        

Each year in the Medicare Physician Fee Schedule final rule, CMS publishes the RVUs for every CPT code in an Excel file known as Addendum B. That file for 2015 is available through the link above.        

Remember to Use the Fair Health Discount Code 
ACEP has arranged for its members to receive a 20% discount on the FH Fee Estimator, a new source of independent charge data from private insurance claims.  

Medicare 2014 E/M Frequency Distributions
2014 Medicare frequency distribution data for Emergency Physicians. (This is the most recent data available)     

FAQ on Reimbursement and Coding Updated
Revisions to the CPT and ICD 10 codes always spark a few questions. ACEP has updated its FAQs in reimbursement reflect changes for 2016.
Visit the FAQs section to view the updated lists      

Coding and Reimbursement Pearls
These are short tips, typically between 50 and 150 words, you can use to quickly learn coding and documentation rules to maximize your payment for the services you provide.

Template Letters for Appealing Denied Claims     
These letters have been prepared to assist in appealing some of the most common denials experienced by emergency medicine practices.

What Every Graduating Resident Needs To Know About Reimbursement    
As a recent residency graduate, you should have a thorough understanding of the basics of two important reimbursement issues: coding and billing.

Billing Hassles Log     
Provides a mechanism for practices to report denials from payers on processed claims.  

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