Your hospital has just received a reimbursement rejection from the fiscal intermediary for two outpatient procedures that were performed on the same day. This rejection was probably generated by....A. the CCI outpatient code editor B. the internal auditing program C. the HAVEN Software
To determine the most likely source of the reimbursement rejection for the two outpatient procedures performed on the same day, we can look at the options provided:
A. The CCI outpatient code editor: The Correct Coding Initiative (CCI) is a tool used to ensure proper coding and bundling of services performed on the same day. It checks for procedure code combinations that are mutually exclusive or not typically reported together. If the CCI outpatient code editor detected an inappropriate combination of codes for the two procedures, it could result in a reimbursement rejection.
B. The internal auditing program: Hospitals often have internal auditing programs in place to review claims for accuracy and compliance with billing regulations. If the internal auditing program identified an issue with the claim, such as improper documentation or coding errors, it could lead to a reimbursement rejection.
C. The HAVEN Software: HAVEN (Healthcare Analysis and Visualization Environment) software is a tool used for analyzing healthcare data, including claims and reimbursement information. While HAVEN Software can provide insights into reimbursement trends and patterns, it is less likely to directly generate a reimbursement rejection.
Based on the options provided, the most likely source of the reimbursement rejection for the two outpatient procedures performed on the same day would be A. the CCI outpatient code editor. This tool actively checks for coding combinations that may not meet reimbursement criteria, and if it identifies an issue, it could result in a rejection.