Medicare Changes for Critical Care Services: Key Insights and Billing Guidelines

Critical Care Services saw a huge change in 2022 from Medicare in the way shared services are provided between a physician and a midlevel provider. We will cover the time-based aspect of how this works and the application of the FS modifier. Medical necessity must be documented accurately for each segment of time included in the aggregate of the total time submitted. The webinar will cover how best to do this.

Then the issue comes up around who actually gets to report and bill the service. Midlevels are now allowed to report critical care. The person providing the substantive portion of the service should be the entity that submits the bill. Charge capture at this point is a real challenge. We will discuss solutions for how to best achieve the most accurate and compliant reporting of split/shared critical care services.

Why is this topic important?
Critical Care services are heavily reviewed and frequently miscoded setting a practice up for audit. The Center for Medicare and Medicaid Services (CMS) has recently revisited the application and definition of these services. This is a subject that requires review and an updated understanding of how and when to use these evaluation and management services. Today’s environment of controversy around critical care for COVID, sepsis, respiratory failure and other life threatening illnesses make correct capture of these services a vital skill for coders.

Who would benefit from this topic?
Professional fee coders who code for providers who care for critically ill patients in the emergency room, the inpatient critical care areas, and surgical specialties that care for critically ill patients pre and post operatively. Outpatient facility coders for the emergency room would also benefit from this lecture.

What information or new skills will the attendee take away from this webinar?
-Understand the recent updates to critical care services from CMS
-Learn the appropriate application and bundling issues related to critical care services
-Understand what makes a patient “critical” and the parameters to look for in the patient record.
What’s the presenter's background/expertise on this topic?
Nancy has been a coder for 30 years and was a critical care nurse for 10 years before that. She has coded and audited for a large trauma one center with Medical, Surgical, Neuro ICUS and a burn unit.

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