All messages should be posted in plain text. HTML will be converted to attachments. The meditech-l web site is MTUsers.com ======================================
We had a representative here from our FI (Mutual) last week and he informed us that we need to use both G0379 and G0378 when it is a direct admit. I did not catch that from the regs... Anyone else already aware of that? If so, how are you handling in MT? I am thinking we can now hardcode the G0378 to the OBS hourly charge. Somehow we'll also need to get the G0379 with a quantity of one on there when it is a direct admit... -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Mills, Dana Sent: Thursday, March 02, 2006 6:47 AM To: '[EMAIL PROTECTED]' Subject: [MEDITECH-L] MEDICARE REQUIREMENT OF CODING OBSERVATION PATIENTS All messages should be posted in plain text. HTML will be converted to attachments. The meditech-l web site is MTUsers.com ====================================== 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. ------------------------------------------------------------------------ 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 DISCLAIMER: The contents of this e-mail message may be privileged and/or confidential. If you are not the intended recipient, any review, dissemination, copying,distribution or other use of the contents of this message or any attachment by you is strictly prohibited. If you receive this communication in error, please notify us immediately by return e-mail or by telephone (919-934-8171), and please delete this message and all attachments from your system. Thank you. READER BEWARE: Unencrypted, unauthenticated Internet e-mail is inherently insecure. Internet messages may be corrupted or incomplete, or may incorrectly identify the sender. Please contact me if you wish to arrange for more secure communication or to authenticate this message. Donna Gibbons Compliance Officer Johnston Memorial Hospital (919) 938-7121 _______________________________________________ meditech-l mailing list [email protected] http://mtusers.com/mailman/listinfo/meditech-l _______________________________________________ meditech-l mailing list [email protected] http://mtusers.com/mailman/listinfo/meditech-l
