When it comes to outpatient services, physicians are paid using CPT/HCPCS codes. Where as inpatient/hospitals are paid using a complex formula (MS-DRG), because of housing, feeding, and nursing the patient back to health. During an inpatient stay the hospital charges for the amount of time and effort spent on nursing a patient back to health. So when it comes to an operation on an elderly person, a complicated birth or even replacing an old pacemaker, the hospital will charge based on the severity of the patient’s illness. That is why inpatient coding requires daily coding of each service on each day of hospitalization, as for outpatient coding, the first listed diagnostic code indicates the reason for the encounter.…
The Healthcare Common Procedure Coding System (HCPCS) are codes that are for reporting professional services, procedures and supplies. Included in that is medical equipment , ambulance services, orthotics, supplies, medication and dental procedures. The HCPCS was developed by the Health Care Financing Administration in 1983. As of 2001 the HCFA is now Centers for Medicare and Medicaid Services (CMS). HCPCS is divided into two subsystems, Level I and Level II. Level I is CPT (Current Procedural Terminology) is used for medical procedures and services done by healthcare professionals. Level I codes are all numeric. Level II codes are used to identify products, supplies and services not included in the CPT codes, such as Ambulance, prosthetics…
There are a few differences and similarities among small, medium, and large facilities concerning the organization of patient records and in how they handle loose reports. I have noticed that most facilities prefer that their loose records are permanently anchored in their charts, which makes sense to me because it prevents the loose reports from being misplaced and lost. However, the different sizes of facilities tend to organize patient files differently according to each particular facility’s policies. The most popular methods of organization that I have seen include chronologically, form numbers, report type, and category.…
The Healthcare Common Procedural Coding System (HCPCS) was created in 1978 and is based off CPT codes to provide a standardized coding system for descriptive specific services and…
Current procedural terminology is an imperative part of the medical billing process. CPT codes are standard procedure codes used for medical, surgical and diagnostic services. Payers use these CPT codes to determine payments, CPT codes work with ICD codes to create a full picture of the healing process for the payer. Having the correct procedural codes ensures that providers receive the appropriate reimbursement. There are three types of CPT codes: Category I, Category II and Category III. I try to remember the codes as “five digits to performance for technology.” Category 1 codes are five-digit numeric codes that are the main body of CPT. These codes are used to identify the CPT and represent procedures done within the medical practice. The regulations have…
What do you think is the reasoning for not filing incident reports in medical records? Provide examples of three incidents and explain why they could be problematic in patients’ files.…
Alzheimer’s disease? , Which is a case study, was very helpful for anyone whom may be researching such a case? The article basically provided explanations as to how the research for the article at hand. Research requires a lot of time and discipline. It is a vital process that contains specific stages, which we like leads to valid conclusions. The stages that are involved consist of selection of an issue to conduct the research on form a hypothesis, review the information that is backing up the hypothesis and also providing an explanation and formulating a useful conclusion. Case control study which was conducted within this article, consisted of participants and informants who provided consent written/verbal to have these studies done on their self’s. The research design that was used to identify and provide factors which were thought to play a role within certain medical conditions. When research is conducted there usually follows a hypothesis to be formulated. In this particular case study there were a total of 217 participants which all were diagnosed to have onset Alzheimer’s disease. The gender break down of the case study consisted of 57 males and 160 females. The control groups were composed of 76 siblings who do not have the same condition which was Alzheimer’s. The control group consisted of 32 males and 44 females and ages ranged between 61-68 years…
A sound knowledge of medical coding guidelines and regulations including compliance and reimbursement – allowing a CPC to better handle issues such as medical necessity, claims denials, bundling issues and charge capture…
All of these characteristics are characteristics of a knowledge and value based manager. The first one is vision; this helps because everyone starts something with a view of what it will become. This will also help motivate the staff to do their best because knowing the company succeeded is because the whole team has worked together. You need a vision so you have a goal or something to work towards. A manager needs to be efficient, because they have many responsibilities that need to be fulfilled and people depending on them. They also need to be organized because they have so many responsibilities and tasks that need to be done in a timely manner.…
Review Procedures and Documents from Physicians: Every physician will provide a written record of the procedures performed with each patient. As a medical billing and coding specialist, you’ll be expected to translate these procedures into numerical codes read…
The article that I have chosen is Spinal Bifida A Multidisciplinary Prospective. In this article it explains the different effects of spinal bifida within different domains , with an effort to promote awareness and different treatments. This article also focuses on treatment statigies and that can help with the developmental disabilities associated with Spinal Bifida.…
Throughout my intensive learning at Midlands Technical College Health Information Management Program, I have achieved coding comprehension of ICD-10 CM, HCPCS, CPT, PCS codes. Not only did I graduate from the program, but earned a highly known credential in the healthcare field: RHIT. The clinical portion of my program allowed me to learn the importance of coding edits involving claims. Centers of Medicare and Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) to promote national correct coding procedures and control improper coding leading to inappropriate payment in Part B claims. The National Correct Coding Initiative contains two types of edits: The first edit is NCCI procedure-to-procedure (PTP) edits define…
Medical billing and coding are the key resources in providing healthcare organization revenue and salaries. Based on the amount of each patient visit and if the visit was cleared and processed. The medical coder and biller must collect the accurate information, which can provide hospitals reliable revenue to function.…
A medical billing and coding specialist’s main goal is to provide medical billing and coding services so the health provider is paid for medical services rendered. Every medical service is assigned a numeric code to define diagnostics, treatments and procedures. It is the medical biller and coder’s job to enter this information into a database using medical billing and coding protocol to produce a statement or claim. If the claim is denied by the third-party payer, the medical billing and coding specialist must investigate the claim, verify its information, and update new details into the database. Medical billing and coding specialists are also responsible for dealing with collections and insurance fraud.…
Billing and coding is not a new IT field and has been around for many decades. For several decades medical billing was done almost entirely on paper. The need for standardized information has grown since the beginning of the Medicare program in 1965. As new systems for reimbursement were developed, a need for specialized information grew and several types of coding methods were created, in addition to one that was already in existence. The International Classification of Disease (ICD) was developed and published by the World Health Organization (WHO) about seventy-five years ago to classify disease and diagnoses. This is currently used throughout the world and has been through 10 different modifications. The U.S. is now using the ICD 9-CM (ninth clinical modification), while many others countries have switched to ICD 10. Other coding systems used with ICD 9-CM are CPT 4 (Current Procedural Terminology, 4th Revision) which is used for coding operations and diagnostics procedures and HCPS(Healthcare Common Procedural Coding Systems), used for coding medication, supplies and other…