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Author Mehrotra, Ateev, author.

Title Developing Codes to Capture Post-Operative Care / Ateev Mehrotra, Courtney A. Gidengil, Lee H. Hilborne, Barbara O. Wynn.

Publication Info. Santa Monica, Calif. : RAND, [2016]


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Description 1 online resource (xii, 40 pages) : color chart.
Series Research report ; RR-1526-CMS
Research report (Rand Corporation) ; RR-1526-CMS.
Note "July 19, 2016"--Table of contents page.
Bibliography Includes bibliographical references (pages 38-40)
Contents Preface -- Tables -- Figure -- Summary -- Acknowledgments -- Abbreviations -- Glossary -- 1. Introduction: Background -- Project Objectives -- Organization of this Report -- Clarifications on Terminology -- 2. Overview of Current Payment Policy for Post-Operative Services in the Global Period: Process for Determining Valuation of Global Procedures -- Billing for Post-Operative Services Provided During the Global Period -- 3. Interviews on Post-Operative Care: Interview Sampling Approach -- Interview Guide -- Interview Findings -- Summary of Interview Findings -- 4. Challenges Identified During Interviews and Expert Panel in Capturing Post-Operative Care via Codes: Expert Panel -- Challenges Identified During the Interviews and/or Expert Panel -- Summary of Challenges Associated with Capturing Post-Operative Care -- 5. Options for Capturing Post-Operative Care: Setting of Care -- Existing E&M Codes -- Scope of Care -- Time -- Summary of Options -- 6. Recommendations for Capturing Post-Operative Care: Proposed Framework of Post-Operative Codes -- Inpatient Codes: A, B, and C -- Office-Based Visit Codes: D and E -- Code for Non–Face-to-Face Care: F -- Codes for Clinical Staff: G and H -- Choosing the Correct Time Increment -- Summary of Recommendations -- 7. Summary and Next Steps: Other Considerations -- Next Steps -- Conclusion -- References.
Summary "The Centers for Medicare & Medicaid Services (CMS) uses a fee schedule to pay physicians and nonphysician practitioners for their professional services. For many surgeries and other types of procedures, Medicare's payment for the procedure includes post-operative visits delivered during a global period of ten or 90 days anchored on the surgery date. The Medicare Access and CHIP Reauthorization Act of 2015 requires CMS gather the necessary data to appropriately value post-operative care. The law requires CMS to collect data on the "number and level" of visits in the global period from a representative sample of physicians beginning January 1, 2017. Congress suggested, but does not require, that the data be collected through claims. CMS asked the RAND Corporation to provide recommendations on how to best collect the number and level of post-operative visits through the use of nonpayment claims. To do so, RAND first gathered input from individuals performing surgical procedures on the range of post-operative care provided during the global period. RAND consulted with an expert panel on how to categorize the care into codes that capture the major differences in the breadth and intensity of post-operative care across care settings. This report provides recommendations for a set of nonpayment codes that combine visit times with the complexity of services, for both inpatient and office-based services. The recommended codes attempt to balance the need for a simple and straightforward system with the demand for a set of codes to capture the granularity and heterogeneity associated with post-operative care delivery"--Publisher's description.
Note Online resource; title from PDF title page (RAND, viewed July 19, 2016).
Subject Postoperative care -- United States -- Costs.
Managed care plans (Medical care) -- United States.
Medical fees -- Law and legislation -- United States.
Health insurance claims -- United States.
Postoperative Care -- economics.
Managed Care Programs.
Fees, Medical -- legislation & jurisprudence.
United States.
Added Author Rand Corporation, publisher, issuing body.
ISBN 9780833095411 (electronic bk.)
0833095412 (electronic bk.)
9780833096296 (electronic bk.)
083309629X (electronic bk.)
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