Outpatient Cardiac Rehab: Tools and Best Practices for Reimbursement and Compliance, 2nd Edition
Kimberly Anderwood Hoy, JD, CPC
Softcover Book: 156 pages + bonus CD-ROM
Size: 8.5" x 11" book + CD-ROM
HCPro / Opus
Compliance and cardiac rehab professionals don't need to look any further for a resource to keep their organization on focus and operating within the letter of the law.
This book and CD-ROM set updates compliance professionals, physicians, non-physician personnel, billers, and coders on changes to the cardiac rehab national coverage determination. Complete with a CD-ROM, this valuable resource offers best practices, sample procedures, and worksheets.
Print forms and put them to use in your facility. Learn about expanded coverage for additional diagnosis groups and changes to physician-supervision requirements and the incident-to rule. This compliance kit gives you best practice advice, case studies, and sample policies and worksheets you need to improve compliance with OIG mandates.
This book includes a CD-ROM that provides customizable policies and worksheets, making it even easier-and faster-for you to get started immediately. You and your staff need to stay up-to-date and well informed in three key areas. You need to understand:
- what the OIG and CMS' look for when monitoring and auditing outpatient cardiac rehab programs
- the compliance risks associated with running a cardiac rehab program that fails to meet compliance
- the confusion surrounding incident-to billing and physician supervision requirements
Outpatient Cardiac Rehab: Tools and Best Practices for Reimbursement and Compliance provides you with:
- an outline of the rules and regulations from CMS and fiscal intermediaries
- case scenarios and best-practice examples from providers that have worked with their FIs to resolve compliance issues
- tools and tips, including job descriptions for physicians that clearly define their roles and time commitment for cardiac rehab, training materials for staff, checklists, forms, audit plan, and a risk assessment plan
- sample policies and procedures on the included CD-ROM that you can use immediately
The Office of Inspector General (OIG) continues to watch cardiac rehabilitation services closely. The proof is in the more than 30+ programs it has audited to date. Continued violations citing incident-to and lack of direct supervision. Most of these violations deal with lack of physician participation in the care of cardiac rehab patients, as well as billing and coding errors. The OIG has its eye on your cardiac rehab program. Here's help to keep it on track. What can you do to make sure your program stands up to scrutiny? Turn to this book and CD-ROM package. The provided explanation, resources and tools fully cover these critical subject areas:
- Acronym and Terminology lists
- Legal: Current Environment of Cardiac Rehabilitation Programs
- Office of the Inspector General (OIG) Audit Summaries
- Analysis of the OIG Summaries
- Summary of Reviews
- Medical: Basic Anatomy and Medical Conditions
- Cardiac Function and Medical Necessity Documentation
- Auditing Charts: Orders and Exercise Prescriptions
- Worksheet for Auditing
- Using the CPT Codes
- Reading LMRP/LCD
- Allowable Codes
- Reading the UB 92 and HCFA 1500
- Denials and Appeals Process
- Future Trends
- The Future of Cardiac Rehabilitation Programs
- Case Studies
With more than 17 years of experience, HCPro, Inc. is a leading provider of integrated information, education, training, and consulting products and services in the vital areas of healthcare regulation and compliance. The company's mission is to meet the specialized informational, advisory, and educational needs of the healthcare industry. As an acknowledged industry authority in healthcare regulation and compliance, HCPro focuses on providing its expertise in the areas of accreditation, medical staff affairs, credentialing, privileging, medical record management, regulatory compliance, nursing, quality/patient safety, infection control, and workplace safety.
Kimberly Anderwood Hoy, JD, CPC, has served as a compliance officer and in-house legal counsel for hospitals. As a hospital compliance officer, she regularly provided research and guidance on coding, billing, and reimbursement issues for a wide range of hospitals, and conducted regular, detailed audits of the cardiac rehabilitation program.
Please remember: The government no longer allows a grace period for annual code sets. The new HIPAA Transaction and Code Set Rule requires providers to use national medical code sets that are valid at the time that a service is provided. ICD-9-CM code revisions become effective October 1st each year while CPT and HCPCS code revisions become effective January 1st. In order for you to meet this requirement, you must have the revised CPT, HCPCS, and ICD-9-CM codes in your possession before the implementation dates. The best way to do this is to order your code books early. Review current coding resources.
(information from the publisher)
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