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Book Cover
Author Mehrotra, Ateev, author

Title Developing codes to capture post-operative care / Ateev Mehrotra, Courtney A. Gidengil, Lee H. Hilborne, Barbara O. Wynn
Published Santa Monica, Calif. : RAND, [2016]
Online access available from:
JSTOR Open Access    View Resource Record  


Description 1 online resource (xii, 40 pages) : color chart
Series Research report ; RR-1526-CMS
Research report (Rand Corporation) ; RR-1526-CMS
Contents 1. Introduction -- 2. Overview of current payment policy for post-operative services in the global period -- 3. Interviews on post-operative care -- 4. Challenges identified during interviews and expert panel in capturing post-operative care via codes -- 5. Options for capturing post-operative care -- 6. Recommendations for capturing post-operative care -- 7. Summary and next steps
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
Notes "July 19, 2016"--Table of contents page
Bibliography Includes bibliographical references (pages 38-40)
Notes Online resource; title from PDF title page (RAND, viewed July 19, 2016)
Subject Health insurance claims -- United States.
Managed care plans (Medical care) -- United States.
Medical fees -- Law and legislation -- United States.
Postoperative care -- United States -- Costs.
Managed Care Programs.
Postoperative Care -- economics.
Fees, Medical -- legislation & jurisprudence.
United States.
Form Electronic book
Author Rand Corporation, publisher, issuing body
ISBN 0833095412 (electronic bk.)
083309629X (electronic bk.)
9780833095411 (electronic bk.)
9780833096296 (electronic bk.)