TH‐C‐224‐01: Reimbursement: Resources and Updates

Healthcare reimbursement is a complex, changing environment with multiple payers and multiple sets of rules. The practicing medical physicist should be familiar with reimbursement and coding so that he/she can: 1) assure that fair reimbursement is received for the physics work performed, 2) assure that physics billing is done correctly and in compliance with applicable rules and procedures, and 3) justify the physics staffing levels necessary in the clinic. This presentation will build upon previous general reviews of the mechanisms of Medicare reimbursement and will cover practical aspects for the practicing physicist including where to find information on reimbursement and coding. The National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUE) and their effect on daily billing will be reviewed. In addition, proposed changes in the Hospital Outpatient Prospective Payment System (HOPPS) and Medicare Physician Fee Schedule (MPFS) for calendar year 2012 will be discussed. Learning Objectives: 1. Become familiar with available resources for reimbursement and coding 2. Understand the National Correct Coding Initiative and Medically Unlikely Edits 3. Be aware of proposed changes in Medicare reimbursement for 2012