So the part in the CMS Manual about Part B services doesn't apply to services off the unit in CT, MRI or Nuc Med?
Thanks for your help. I use average times but our system calculates observation hours based on start and end observation time entered in boxes. In a separate program, carve out time must also be entered based on a start and stop time. If we just manually adjust the observation hours, the system will reverse the manual charges and post back charges based on the original start and end times. Like you've said, it's a lot of work for little return.
This process is one that always has me scratching my head.... and asking, why do we have to do this.... since as many have mentioned, it rarely impacts our MCR payment. With that said, we have tried to simplify this as much as possible in our Epic workflows. We have OP charge capture staff that will carve out time in the ADT event manager depending on ordered and documented services. Average times for some services and actual times for others. For surgeries and Cath Lab/EP procedures it is as easy as changing the ADT event to OP so that OBS charges don't calculate for that time period. We have also considered automating this within Epic, but have not taken that step yet.
Which group of individuals do the carve outs at your organization? Is this process done by staff in the Revenue Cycle or do you have Utilization/Case Management doing this work? Do any organizations automatically carve out the time using Epic functionality/build? Thank you!
We have a small team of revenue capture analysts that manage the OBS carve out as part of their review and charge capture for nursing ancillary services. They capture charges for all OP/OBS and ED patients. We have chosen not to automate the carve out in Epic, but if others have had success with it, we would possibly reconsider.
Thank you for your response - do you mind sharing what organization you are from?
Community Health Network, Indianapolis, IN