Nimitt Consulting devotes considerable time to creating tools that provide expert advice on effective APC/OPPS implementation strategies. Ms. Shah is a leading member of several editorial groups working to answer complicated APC-related questions and to streamline the process for healthcare agencies. The resources listed below contain helpful suggestions, useful advice and timely strategies to manage healthcare delivery under the APC/OPPS environment.
OPPS Drug Administration
Strategies: Your Comprehensive Guide to Accurate Coding, Billing and
Charging
Ms. Shah and
co-author Jennifer McPeek present a comprehensive
resource to help hospital providers navigate the 2005 OPPS
drug administration coding, billing and charging rules. The book shows providers
how to accurately and completely report chemotherapy and
non-chemotherapy injection and infusion services so they generate the
revenue they are due while remaining in compliance with the rules
The book and accompanying CD include:
- Audit question and report templates to use right away
- Detailed analysis of
Transmittal 404 and a web link that showcases the latest information
released by CMS on June 3, 2005 in Transmittal 573
- Tips for updating the charge description master, charge tickets and encounter forms
- Clinical scenarios for use in training nursing and infusion room staff
- True-false tests to assess your knowledge and help educate staff
- Answers to frequently
asked questions
- View the Table of Contents
- Click HERE for your Author Discount
- Order the 2005 OPPS Drug Administration Strategies: Your Comprehensive Guide to Accurate Coding, Billing and Charging
The Drug Revenue Toolkit
Jugna Shah offers this simple and easy-to-use booklet to help you assess your hospital's opportunity to capture new drug revenue through Medicare billing. Using interactive flowcharts, worksheet tools and a CD, this publication walks you through the process of billing future claims for generic,
brand-name and new drugs. You’ll also learn how to rebill prior claims to capture money that is now available in Medicare’s new reimbursement option.
The Drug Revenue Toolkit gives you the chance to unite finance, pharmacy, health information management, and compliance staff to improve drug acquisition and operations, and quickly capitalize on the revenue rebilling and future billing opportunities from the Medicare Modernization Act. Among the tips and tools in the book and on the accompanying CD-ROM are:
- Four flow charts, six tables, and two worksheets that can be customized for your specific hospital
- Instructions that will help you identify your hospital's specific claim rebilling and future billing opportunities for use of brand name drugs from January 1 to March 31, 2004
- A case-study featuring "Any Town Hospital," along with the author's analysis
- Steps on how to bill brand-name versus generic drugs correctly under new federal rules
- Tips for using new brand-name radiopharmaceutical codes, handling supply challenges, and charging when you stock both generics and brand-name drugs
- Implementation pitfalls and tips
- Six-step checklist for identifying and rebilling claims
- Order the Drug Revenue Toolkit
Compliance
Troubleshooter: Tackling the Top 10 Compliance Challenges
Regardless of the confusion, lack of timely guidance, and CMS’ frequent
payment rate and policy changes, the government expects providers to be
in compliance with OPPS regulations. Many providers are seeking a tool
to help ensure compliance and simplify the OPPS process.
Ms. Shah's chapter discusses the top
compliance issues of which providers should be aware under Medicare’s
outpatient prospective system of APCs.
This user-friendly resource
and CD-ROM provide customizable forms and information on OPPS and other
compliance issues including the challenges of inappropriate documentation,
finding the right level, how under-billing can lead to overpayments, suggestions
for internal audits, and tips for identifying partners in outpatient compliance.
Compliance Troubleshooter helps providers set up effective compliance
strategies for ten crucial issues:
- False Claims Act
- Quality of care and compliance
- Economic credentialing
- EMTALA
- Nonphysician practitioners
- Billing and documentation for teaching physicians
- Outpatient PPS
- Outlier payments
- Stark II
- Inpatient billing issues
You receive background for each issue; "how-to" solutions and tools to avoid trouble with the OIG; and practical tips, advice, ideas, and ready-to-implement forms to solve the problems associated with each issue.
Briefings
on APCS
If you need all of the information about APCs at your fingertips, consider
subscribing to Briefings on APCs. Jugna Shah writes the OPPS Advisor
column, and serves as a contributing editor for this monthly publication.
Her role includes identifying important topics to cover based on industry
requests and need.
