Essay On Clinical Coding
The function I chose to discuss is...”Clinical Coding of Diagnoses and Procedures”
Clinical coding… is the process of assigning numeric or alphanumeric classifications to a diagnostic or procedural statement. This function is used for billing and payment purposes, as well as for research and quality performance reviews.
Medical billing and coding specialist are the glue that holds together every healthcare facility… healthcare providers can 't stay in business without the help of good billers and coders, because without them the facility doesn’t get paid. Traditionally in the past, billers have either been trained on the job or have been medical coders who do both the coding and billing. However, there is a shortage of billing/coders
…show more content…
For example, up-coding occurs when a physician examines a patient briefly for a simple matter such as a cold but submits a bill for an hour-long complex visit; or when a pharmacist provides a patient with a low-cost generic but submits a bill for a higher-cost branded drug.
· "Unbundling" refers to the practice of using two or more Current Procedural Terminology (CPT) billing codes instead of one inclusive code. It also refers to the practice of submitting multiple bills in order to obtain a higher reimbursement for tests and services that were performed within a specified time period and which should have been submitted as a single bill.
· "Double billing" occurs when a provider attempts to bill Medicare / Medicaid and either a private insurance company or the patient for the same treatment, or when when two providers attempt to get paid for services rendered to the same patient for the same procedure on the same date. Double billing also occurs when a provider attempt to charge more than once for the same service, for example by billing using an individual code and again as part of a bundled set of
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.
Hsc300 Unit 9 Lab Report
313 Words | 2 PagesMedical biller is a position that will require you to take in medical claims and code them and bill out medical claims to insurance companies, Medicare and Medicaid on a daily basis. You will have to reconcile Explanation of Benefits (EOB) weekly. Verify if insurance companies require that patients get PA for certain procedure and products. Five requirements for Medical Biller position 1. How to bill claims 2.
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.
HCPCS Codes Analysis
1183 Words | 5 PagesHCPCS codes facilitate the procedure of processing health insurance claims made by insurers such as Medicaid. The HCPCS is divided into two levels or classes. The task of classification lies with the Centres of Medicaid and Medicare Services (CMS) in association with the HCPCS work group and other third party payers. Classification is done quarterly, marking a significant step-up from its previous system of annual updates. Since 2014, the CMS has been implementing several changes regarding the continuation of HCSPCS level II.
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.
Certified Coding Specialist Research Paper
277 Words | 2 PagesCertified Coding Specialist are experienced professional coders who use ICD-10-CM and CPT coding systems to categorize information from patients medical records for insurance reimbursement purposes (AHIMA). Retrieve medical records of patients for review of clinical data. Assign codes accordingly per ICD-10 and CPT coding guidelines. Communicate and cooperate with healthcare facility and billing offices.
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
ICD-10 Myths
589 Words | 3 PagesMyths about ICD-10 So, the ICD-10 deadline whisked past us last week, and even still there are many practices that have not been able to understand the ICD-10 concept fully. Many physicians have been hearing things about ICD-10, most of which are not actually true. As a result, the ICD-10 implementation has been perceived much more complex than it actually is.
Unbundling Persuasive Essay
120 Words | 1 PagesUnbundling which is also known as fragmentation is the practice of submitting bills piecemeal or in a fragmeted fashion to maximize reimbursement. I think unbundling is considered a fradulent method of coding because Medicare and Medicaid requires certain procedures to be billed under one code. If these guidelines aren 't being followed it 's to obtain a higher reimbursement rate. I think unbundling is an unethical practice because it 's legally wrong as well as morally to try to gain higher incentives for personal gain. " Manipulating or altering billing codes to maximize reimbursement from government healthcare programs like Medicare and Medicaid is a type of healthcare fraud that can be reported by whistleblowers under the Qui Tam
Julie Thao's Medication Attack Case Study
541 Words | 3 PagesAt the time of the event, a bar coding system for all medication had been in effect for a duration of two weeks, however, Thao had been gone one of those crucial weeks. Because of her absence, she did not receive the adequate training, instead, she received a sped
Hcs 589 Strategic Plan Part 1 Organizational Structure Paper
1780 Words | 8 PagesCoronis health leadership team has discussed implementing of Radiology billing. Radiology billing is unique, and the radiologist are not client facing in most cases. Of course, there are those special radiological procedures where a radiologist is in the room, but for radiology billing. The radiologist is obtaining billing information passed on from a hospital or surgery center facility. It is hard enough to obtain correct information from the patient when the patient is sitting in front of you.
More about Essay On Clinical Coding
56431 Unit 1
638 Words | 3 PagesColumn1-59 Modifiers
250 Words | 1 PagesComparison Of HCPCS Level II And CPT
458 Words | 2 PagesHsc300 Unit 9 Lab Report
313 Words | 2 PagesICD-10 Summary
489 Words | 2 PagesHcpcs Level 1 Research Paper
76 Words | 1 PagesHCPCS Codes Analysis
1183 Words | 5 PagesE/M Coding: What Was Done In The Office
283 Words | 2 PagesCertified Coding Specialist Research Paper
277 Words | 2 PagesIcd 10 Research Paper
393 Words | 2 PagesIcd-9 And Icd-10 Transition
523 Words | 3 PagesICD-10 Myths
589 Words | 3 PagesUnbundling Persuasive Essay
120 Words | 1 PagesJulie Thao's Medication Attack Case Study
541 Words | 3 PagesHcs 589 Strategic Plan Part 1 Organizational Structure Paper
1780 Words | 8 Pages