How do inpatient and outpatient billing differ in Resolute in terms of coding and claim submission?

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Multiple Choice

How do inpatient and outpatient billing differ in Resolute in terms of coding and claim submission?

In Resolute, inpatient and outpatient billing use different coding sets and different 837 claim formats to reflect the way services are billed. For inpatient stays, diagnoses are coded with ICD-10-CM and the procedures with ICD-10-PCS, since inpatient procedures are captured at the procedural level within the hospital setting. These inpatient institutional claims are submitted using the 837I format. For outpatient encounters, diagnoses are coded with ICD-10-CM, but procedures are billed with CPT or HCPCS codes to describe the ambulatory services provided. Outpatient professional charges are submitted on the 837P format, while institutional outpatient charges would use the 837I format if applicable. So, the correct alignment is: inpatient uses ICD-10-CM/PCS with 837I; outpatient uses ICD-10-CM and CPT/HCPCS with 837P (professional) or 837I for institutional outpatient as appropriate. This matches the stated option.

In Resolute, inpatient and outpatient billing use different coding sets and different 837 claim formats to reflect the way services are billed.

For inpatient stays, diagnoses are coded with ICD-10-CM and the procedures with ICD-10-PCS, since inpatient procedures are captured at the procedural level within the hospital setting. These inpatient institutional claims are submitted using the 837I format.

For outpatient encounters, diagnoses are coded with ICD-10-CM, but procedures are billed with CPT or HCPCS codes to describe the ambulatory services provided. Outpatient professional charges are submitted on the 837P format, while institutional outpatient charges would use the 837I format if applicable.

So, the correct alignment is: inpatient uses ICD-10-CM/PCS with 837I; outpatient uses ICD-10-CM and CPT/HCPCS with 837P (professional) or 837I for institutional outpatient as appropriate. This matches the stated option.

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