Attribute: Revenue Code
A revenue code is a specific identifier used in the healthcare industry for billing purposes. It categorizes and defines the type of service provided to a patient, which is then used to bill insurance companies.
Revenue codes help ensure that healthcare providers are reimbursed accurately for their services. They are crucial because incorrect categorization can lead to significant financial losses, as claims may be denied or payments delayed if the billing is done incorrectly.
Data Source
Revenue codes are maintained by Centers for Medicare & Medicaid Services (CMS) and, in Data Connect, maintained by the Internal GHX HCPCS Coding Specialists with CPC Certification through the American Academy of Professional Coders (AAPC).
Standardization
GHX assigns revenue codes based on guidance from Centers for Medicare & Medicaid Services (CMS), which may differ from how the manufacturer assigns these codes to the products they sell.
Considerations
Due to the inability to distinguish between inpatient and outpatient products, the assigned revenue codes are for hospital inpatient reimbursement only.
Revenue code assignment is based on the billable status of the item; however, it does require alignment with the procedure code to ensure successful processing of a claim by insurers. GHX does not provide procedure codes.
GHX applies revenue codes based on Centers for Medicare & Medicaid Services (CMS) Diagnosis Related Groups (DRG) payment guidelines, which aligns with how Medicare reimburses the facility.
Items with an HCPCS status of Coded or No code are assigned a revenue code. Items with an HCPCS status of Non billable are not assigned a revenue code.