This page contains a number of documents of interest to those involved in coding, billing, documentation and reimbursement for hospitals, clinics and integrated systems.

Please visit our specialty sites for further information regarding APCs and HIPAA:

APCNow.com

HIPAAMaster.com

This page was last updated on April 24, 2001

  • Documents are provided in four different formats as appropriate:
    • Microsoft Word Version 8.0/9.0 (Word 2000) - .doc,
    • HTML - Version 4.0 - .html or .htm, and
    • Adobe Portable Document Format - .pdf
    • Microsoft Excel Version 8.0/9.0 (Excel 2000) - .xls

  • Download the EMTALA and Provider-Based Status [proposed] rules from the Federal Register updates (May 9, 2002). This download includes both the preamble and CFR proposed changes.

The following documents provide a compliation of information concerning Provider-Based Status or PBS for short. All the documents are in PDF format. There are also several links to additional sources of information.

Provider-Based Status Rules From April 7, 2000, Federal Register
Provider-Based Status Preamble From April 7, 2000, Federal Register
Program Memorandum A-99-42
42CFR489.24
42CFR409.3
42CFR410.27
42CFR412.22
42CFR412.25
42CFR489.2
42CFR489.22
Chapter 6 HCFA PBS Training Materials

Also, check the following links:

EMTALA Information
HCFA PBS Questions and Answers

Also, the November 13, 2000, Federal Register (APC Update) and the November 1, 2000, Federal Register (RBRVS Update) can be downloaded from your favorite GPO Gate. Note that these are long Federal Register entries, so they are in pieces. Both the complete April 7, 2000, and November 13, 2000, Federal Register entries can be downloaded from our sister site, APCNow.com

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The following eight items provide information on CMS's Interim Pass-Through Items Note that some of this information is cumulative. The documents are provided in the order in which they appeared from HCFA. Note that for DME implantalbe items (e.g. pacemakers) the payment rate is determined by taking the hospital's CCR (Cost-To-Charge Ratio), as supplied by Medicare, and multiplying it times the charge. You must thus set your charge at a high enough level just to recover your costs.

All of these documents are in PDF format.

First Pass-Thru Listing
PM A-00-42
PM A-00-61
PM A-00-72
PM A-00-82
PM A-01-40
PM A-01-41
C-Codes Not Cross Walked To Category-Specific Codes

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The following link provides a combined copy of the April 7, 2000, Federal Register entry for APCs in PDF format. This document can also be downloaded in 8 parts from any of the GPO (Government Printing Office) gateways. One such GPO gateway is Click Here To Go To A GPO Gateway Use a keyword such as "Medicare" and put in the April 7th date for a search. Note that you will have to name each of the parts as you download them.

Click Here To Download Complete APC Federal Register This is from the AACI Web Site. The complete FR entry in PDF format allows for searching by keywords through the Adobe Acrobat Reader.

The pre-publication documents are still available at the HCFA web site: Go To HCFA Web Site. There are 25 different documents in various formats including PDF, WordPerfect, MS Excel and self-executing ZIP files. These files can be very useful if you need to copy specific information or put financial information into a spreadsheet.
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Sample Encounter Forms and Charge Master Entires.

The following are in spreadsheet format and are intended for general guidance and educational purposes only! These documents assume that a three level approach is being taken relative to charging for services provided at a hospital ER. The three levels are - Emergent, Urgent and Clinic. Before implementing any changes, hospitals should consult with the FI and other third party payers relative to any special coding and billing rules. Care should also be taken relative to licensing, certification and accreditation standards and principles as well.

The primary reason for making these types of changes is for compliance, i.e., not filing false claims by filing claims that are medically necessary at these three levels, and also for reimbursement purposes since many third party payers will not pay for emergency level services that are not medically necessary as emergencies.

The charges listed here are fictitous and have no relevance in reality. They are based on HCFA's RBRVS with an arbitrary conversion factor. Hospitals will need to develop their charges based upon their actual costs. These calculations are provided only to illustrate the way in which to use relative values.

Emergency Level Charge Master Entries-Professional and Facility - Excel Format - 89 Kb
Emergency Level Charge Master Entries-Professional and Facility - Adobe PDF Format - 36 Kb
ER Level Physician Encounter Form - Excel Format - 21 Kb
ER Level Physician Encounter Form - Adobe PDF Format - 9 Kb
ER Level Facility Charge Slip - Excel Format - 21 Kb
ER Level Facility Charge Slip - Adobe PDF Format - 9 Kb

Note that in the following, RCC=456 can only be used with RCC=451. Be sure to check with your third-party payers to see what their requirements are relative to RCC=456.


Urgent Level Charge Master Entries-Professional and Facility - Excel Format - 77 Kb
Urgent Level Charge Master Entries-Professional and Facility - Adobe PDF Format - 28 Kb
Urgent Level Physician Encounter Form - Excel Format - 21 Kb
Urgent Level Physician Encounter Form - Adobe PDF Format - 9 Kb
Urgent Level Facility Charge Slip - Excel Format - 21 Kb
Urgent Level Facility Charge Slip - Adobe PDF Format - 9 Kb

HCFA's New Extended E/M Coding Documentation Guidelines:

E/M Coding Guidlines - MS Word Format - 405 Kb

E/M Coding Guidelines - Adobe PDF Format - 177 Kb

Note that HCFA has withdrawn these guidelines. New guidelines should be available in the latter part of 1999. The revised guidelines are currently in final testing.

AACI's Comments To September 8, 1998, Federal Register (APCs):

AACI Comments APC Fed Reg - MS Word Format - 72 Kb

AACI Comments APC Fed Reg - Adobe PDF Format - 48 Kb


Job Descriptions Developed By Dr. Abbey:


Note that these job descriptions are modifications of material provided in Dr. Abbey's books which are available from McGraw-Hill Healthcare Education Group.

APC Coordinator Job Descripton - MS Word Format - 25 Kb
APC Coordinator Job Description - HTML Format - 7 Kb
APC Coordinator Job Descripton - PDF Format - 8 Kb

CBR Compliance Officer Job Description - MS Word Format - 29 KB
CBR Compliance Officer Job Description - HTML Format - 8 Kb
CBR Compliance Officer Job Descriptio - PDF Format - 10 Kb

Charge Master Coordinator Job Description - MS Word Format - 16 Kb
Charge Master Coordinator Job Description - HTML Format - 6 Kb
Charge Master Coordinator Job Description - PDF Format - 7 Kb

Chief Security Information Officer Job Description - MS Word Format - 32Kb
Chief Secuirty Information Officer Job Description - HTML Format - 14 Kb
Chief Security Information Officer Job Description - PDF Format - 12 Kb



Suggested APC Workshop Exercise Solutions

Interventional Radiology For APCs(Version 2.2), and
Catheterization/Vascular Laboratory For APCs (Version 1.2)

The following documents are suggested solutions to exercise sets for two special APC workshops most recently presented in Columbus, Ohio, in late March, 2001. The first is on Interventional Radiology, and the second is for Catheterization and Vascular Laboratory Workshops. These exercises are for education and discussion purposes ONLY. They are not intended as definitve guides to coding.

Interventional Radiology Suggested Solutions - MS Word Format - 53 Kb
Interventional Radiology Suggested Solutions - PDF Format - 39 Kb

Cath-Vascular Lab Suggested Solutions - MS Word Format - 81 Kb
Cath-Vascular Lab Suggested Solutions - PDF Format - 40 Kb


We are also anticipating placing past copies of the ACCI Medical Reimbursement Newsletter on this download page. In respect to our paid subscribers (thank-you!), only issues more than three months old will be publsihed at this site starting with the January, 1999, issue.


We have had several questions about the latest payment rates and/or if HCFA is going to publish an updated APC listing. It is doubtful that they will list anything new other than the Program Memorandums with the Transitional Pass Through items. You can find an updated listing of APCs, their mappings and payment rates at the IRP (Information Resources Products - Boston, MA) site Click Here To Go To IRP


.

Additional documents and pertinent information will be provided at this web site including sample CBR Compliance Policies & Procedures.  Also, further information concerning HCFA's APC payment system for Hospital Outpatient Services will also be provided, particularly the steps that need to be taken to optimize reimbursement.