Assignment 1: Healthcare Compliance In Nursing Care
Azemobho Imaku
Western Governors University
Healthcare Compliance
December 15th 2015
An inpatient coder is a professional, skilled at performing coding and abstracting of inpatient accounts using ICD-9-CM (International Classification of Diseases Ninth Revision, Clinical Modification) and CPT (Current Procedural Terminology) coding systems. An inpatient coder is also expected to be knowledgeable in medical terminology, disease processes and pharmacology. Some of the key responsibilities of the position include assigning codes for diagnoses, treatments and procedures, reviewing provider documentation to determine principal diagnosis, ensuring accurate coding, identifying non-payment conditions and ensuring medical record coding meets regulatory
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(2013), are implemented by hospitals to assure the health record accurately reflects the actual condition of the patient. AHIMA provides guidance for clinical improvement programs with goals which include identifying and clarifying missing, conflicting or nonspecific physician documentation related to diagnoses and procedures; supporting accurate diagnostic and procedural coding, DRG assignment, severity of illness, and expected risk of mortality which leads to appropriate reimbursement; promote health record completion during the patient’s course of care; improve communication between physicians and other members of the healthcare team; improve documentation to reflect quality and outcome scores and improve coders’ clinical knowledge. Developing a CDI program as a coding manager will include hiring credentialed and competent individuals with the right education and experience, providing training and in-services for staff and related departments that use clinical documentation on how specific and complete clinical documentation needs to be captured, making sure staff is knowledgeable in State and Federal laws and regulations that govern their positions, adheres to ethical standards set by credentialing and regulatory organizations and making sure staff is aware and exposed to changes and improvements in the industry through continued …show more content…
(2010). Guide to Coding Compliance. Clifton Park, NY: Delmar Cengage Learning. ISBN: 139781111185152
Dignity Health: http://www.dignityhealthcareers.org/careers/jobs/job.php?id=1400024020-inpatient-coder-ii&cat=&media=rep&nt=1&bid=
LaTour, K., Maki, S., & Oachs, P. (Eds.). (2013). Health information management: Concepts, principles, and practice (4th ed.). Chicago, IL: AHIMA. ISBN-13: 9781584263593
Schnering, P. (2014). Professional review guide for the RHIA and RHIT examinations. Cengage. ISBN 9781305325111
Sturgeon, J. (2010) Tips for Setting Productivity Standards For The Record Vol. 22 No. 14 P.
56431 Unit 1
638 Words | 3 PagesThey should be hold accountable for any breach in protocols. • Present format for electronic documentation does not allow for comprehensive clinical documentation during follow-up visit. Efforts should be made to upgrade the electronic medical record system to the standard of that expected for a medical center and research institute. This is to allow for proper documentation according to the industrial standard, and easy retrieval of patient’s information for clinical research. There is a need to employ a clinical documentation improvement specialist (CDIS) in this
Column1-59 Modifiers
250 Words | 1 PagesNCCI is the National Correct Coding Initiative. It 's important There are two categories of edits: Physician Edits: these code pair edits apply to physicians, non-physician practitioners, and Ambulatory Surgery Centers Hospital Outpatient Prospective Payment System Edits (Outpatient Edits): these edits apply to the following types of bills: Hospitals (12X and 13X), Skilled Nursing Facilities (22X and 23X), Home Health Agencies Part B (34X), Outpatient Physical Therapy and Speech Language Pathology Providers (74X), and Comprehensive Outpatient Rehabilitation Facilities (75X). Both the physician and outpatient edits can be split into two further code pair categories: Column1/Column2 Code Pairs: these code pairs were created to identify unbundled services.
Comparison Of HCPCS Level II And CPT
458 Words | 2 PagesInitially, facilities voluntarily used HCPCS codes, but with the implementation of HIPAA in 1996, facilities began to report HCPCS for transaction codes (Webb, 2012). CPT (Current Procedural Terminology) is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations (Rouse, 2015). The HCPCS level II coding system has a selected standard coding system with a wide acceptance among both public and private insurers. The HCPCS level II codes set are alphanumeric code set and primarily include non-physician products, supplies, and procedures not included in CPT. For HCPCS to bill the and identify the service that are been used such as.
ICD-10 Summary
489 Words | 2 PagesHow ICD-10 impacts the revenue cycle management by Sashi Padarthy discusses the “opportunity” for facilities to improve on “clinical documentation, revenue cycle performance, and analytic capabilities for business intelligence” (Padarthy, July 2012, p. 7). Padarthy suggests the shift from ICD-9-CM to ICD-10 will require multi-departmental assessments to determine core factors within ICD-10 will that will directly influence coding, billing and reimbursement. Padarthy proposes facilities analyze their current diagnostic and procedural codes to assess whether their current codes accurately represent services provided. In addition, he asks facilities to determine “if an opportunity to leverage ICD-10” exists, and if so, what is needed; updated eligibility requirements, increased medical necessity
Hcpcs Level 1 Research Paper
76 Words | 1 PagesHCPCS level 1 uses CPT codes to identify medical services & procedures level 2 is used to identify the products, supplies, and services that are not in CPT codes ICD-10 used for diagnosis and in patient procedures There 's so many different types of services and procedures within the medical field that different codes are needed to specifically identify them properly. Coding was created to make medical billing simple. Proper coding will ensure accurate and timely reimbursements.
E/M Coding: What Was Done In The Office
283 Words | 2 PagesIt is important that the E/M codes are done correctly, because if not it could cause a lot of trouble. RE: UNIT7 8/6/2015 1:16:10 PM I agree, E/M coding is the process of which physician and patient encounters.
HCPCS Level 2 Codes
284 Words | 2 PagesHCPCS Level II codes commonly are referred to as national codes or by the acronym HCPCS, which stands for the Healthcare Common Procedure Coding System. HCPCS codes are used for billing Medicare and Medicaid patients and have been adopted by some third-party payers. These codes, updated and published annually by the Centers for Medicare and Medicaid Services (CMS), are intended to supplement the CPT coding system by including codes for nonphysician services, administration of injectable drugs, durable medical equipment (DME), and office supplies. The main terms are in boldface type in the index.
Icd 10 Research Paper
393 Words | 2 PagesWith the number of codes increasing from 14,000 to 70,000, the demand for coders and billing personnel has increased and exceeds local demand. Many healthcare organizations recently have contracted with coding vendors to provide ICD-9 coding assistance, in part to allow in-house coders to undergo ICD-10 training and participate in dual coding. However, It is still unclear how coding professionals and vendors will be impacted long-term by the implementation. According to Forbes, the ICD-10 switch for providers has been better than expected.
Icd-9 And Icd-10 Transition
523 Words | 3 PagesA core element of confidence building is showing the professionals how to value and use information adopted for coded data. This type of information has the power to describe medical necessity in support of admissions, readmission’s and continued stays. An example I would like to give is, by pinpointing
Joint Commission's Tracer Methodology
164 Words | 1 PagesThe Joint Commission’s tracer methodology is used to ensure compliance standards are met, as well as to “trace” and document the level of care provided to patients in order to make improvements to the facility’s health care delivery system. Patients requiring services that utilize the entire continuum of care spectrum are selected in an effort to gather sufficient information needed to identify areas with potential risks and safety concerns. As the patients’ course of care progresses across the system, Joint Commission surveyors evaluate each department 's policy and procedure on data management, infection control and medication management process. Health information management is impacted by the “tracer methodology” because HIM must ensure
Electronic Health Record Annotated Bibliography
1511 Words | 7 PagesPara. 2) The Omaha System remains statistically superior to other interface terminologies of the electronic health record. The efficacy of the Omaha system has been heavily researched and covers numerous types of patients in various types of settings. The authors, well credentialed and academic, thoroughly describe the Omaha system and its benefits for meaningful use achievement.
Medical Coding Career
1123 Words | 5 PagesMedical coding is the right career choice for me. The responsibilities and work expected match well with my personal strengths. The field is growing rapidly. It’s the perfect time to get an Associate’s Degree in Medical Reimbursement and Coding. However, before committing to starting a new career path, there are many questions I need answered about this field.
Icd 9 Case Study
508 Words | 3 PagesGiven the dual coding capabilities is a part of the deal, it is extra work nonetheless. This would invariable result in loss of productivity and practices will need to assign extra coding resources. It is safe to assume that medical coding productivity drops by 50% for medical coders who are not proficient with ICD-10 claims. This claim is no way unrealistic. This means that the time the coders take to assign ICD-10 codes to four medical claims, they miss out on processing 8
After-Visit Summary Kaiser Permanente
213 Words | 1 PagesKaiser Permanente has been equipped since 2007 with Health Connect; which is the largest private electronic health record implementation in the world. This is a highly sophisticated electronic program that integrates inpatient, outpatient, and clinic medical records with appointments, registration, pharmacy, and billing for all kaiser members. In addition, this electronic program includes an entire medical library with a whole set of care support tools which are accessible to doctors, nursing staff and patients (Kaiser Permanente, n.d.). At kaiser permanente; nurses are expected to print out “the after-visit summary” (AVS), which contain the doctor recommendations for each patient that we see.
Anna Liza D. Fernandez Case Summary
1505 Words | 7 PagesShe continuously educates herself with current regulatory changes to ensure compliance and improve missed opportunities. This is evident when local medical center noted "Missed documentations on Code Blue Documentation" during an emergent event in the OR. She seized the opportunity to assist staff to reflect on present practice, identify gaps, list plausible solutions, and integrate recommendations from OIG. Ms Fernandez lead the team for a complete turnaround in practice and resolve the problem in two weeks’ time frame. She headed the in-service for “Code Blue Management in the OR Setting”.
More about Assignment 1: Healthcare Compliance In Nursing Care
56431 Unit 1
638 Words | 3 PagesColumn1-59 Modifiers
250 Words | 1 PagesComparison Of HCPCS Level II And CPT
458 Words | 2 PagesICD-10 Summary
489 Words | 2 PagesHcpcs Level 1 Research Paper
76 Words | 1 PagesE/M Coding: What Was Done In The Office
283 Words | 2 PagesHCPCS Level 2 Codes
284 Words | 2 PagesIcd 10 Research Paper
393 Words | 2 PagesIcd-9 And Icd-10 Transition
523 Words | 3 PagesJoint Commission's Tracer Methodology
164 Words | 1 PagesElectronic Health Record Annotated Bibliography
1511 Words | 7 PagesMedical Coding Career
1123 Words | 5 PagesIcd 9 Case Study
508 Words | 3 PagesAfter-Visit Summary Kaiser Permanente
213 Words | 1 PagesAnna Liza D. Fernandez Case Summary
1505 Words | 7 Pages