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Good Morning,
How are the members of our L-List handling Medicare's reimbursement
requirement of indirect to direct OBS patient charges?
Medicare has made it a requirement for there to be a charge distinction
between direct and indirect OBS Patients.
G0378 - Hospital observation services, per hour (Indirect)
G0379 - Direct admission of patient for hospital observation care
The Meditech system should be able to apply the appropriate code
systematically
based on patient scenario.
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CMS has a new approach to reimbursing observation services that will place
decision making on the Fiscal Intermediary ("FI") OPPS claim processing
logic to
determine whether the service is separately payable. This change is welcomed
by
all, but the new system will require education and payment monitoring for
your
facility.
In the beginning of OPPS, all observation services were packaged. Later in
2002, a separate APC payment was established for observation provided under
certain conditions (chest pain, asthma, or congestive heart failure). The
following year, criteria were introduced to provide a separate payment for
"direct admission" to observation. As of January 1, providers must report
the
following two new G codes to report all observation services and direct
admission for observation, whether separately payable or packaged:
G0378 - Hospital observation services, per hour; and
G0379 - Direct admission of patient for hospital observation care
Both codes are assigned a new status indicator which triggers the OPPS
claims
processing logic to determine if the observation service warrants a separate
APC
payment. This is a relief for providers as they must only determine coverage
for reimbursement purposes and not have to differentiate between packaged
and
separately payable. However, as your local FI will now make sole
determination
regarding observation coverage, you may experience an increase in claims
processing delays or denial activity.
Dana B. Mills, MBHA
MIS Financial Applications Specialist
Johnston Memorial Hospital
509 N. Bright Leaf Blvd.
Smithfield, NC 27577
Ph.: 919-934-8171
Direct: 919-938-7593
Fax: 919-934-8145
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Donna Gibbons
Compliance Officer
Johnston Memorial Hospital
(919) 938-7121
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