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Inpatient Hospital Requirements – DRG and Per Diem concept

by Medical Billing | Nov 3, 2016 | Medicare payment basics

Inpatient services are generally reimbursed based on one of the following: • DRG, or • Per Diem Outlined below are generally accepted billing guidelines. This is intended to be illustrative and is not an all-inclusive list. • The Admission Date field should reflect...

Present of Admission (POA) Indicator list on UB 04

by Medical Billing | Aug 5, 2016 | Medicare payment basics

The table below outlines the payment implications for each of the different POA Indicator reporting options. POA Indicator Options and Definitions Code  Description Y    Diagnosis was present at time of inpatient admission. Florida Blue will pay the...

What is Present on Admission Indicator Reporting ?

by Medical Billing | Aug 3, 2016 | Medicare payment basics

A Present on Admission (POA) Indicator is used to identify whether a primary or secondary condition was present at the time the order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department, observation,...

Per Diem agreement and allowed amount calculation

by Medical Billing | Jul 31, 2016 | Medicare payment basics

Per Diem Per Diem is a per day negotiated rate which represents an allowance that includes all services for that day. Per Diem agreements reimburse based on the admission date of the member. The following terminology is used when referring to per diem contracts: •...

DRG Hierarchy and calculation of allowed amount

by Medical Billing | Jul 28, 2016 | Medicare payment basics

DRG Hierarchy for a Standard Base Agreement Each inpatient case for a DRG contract is evaluated using the following payment hierarchy: • Low Stay Outlier • High Charge/High Stay Outlier • DRG Value Inlier Once a claim meets the criteria for a step in the hierarchy...
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CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved to AMA.
The revenue codes and UB-04 codes are the IP of the American Hospital Association. All Rights Reserved to AMA.
All our content are education purpose only. All the articles are getting from various resources. If you find anything not as per policy. Please reach out and we would do the investigation and remove the article.
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