...The World Health Organization established the International Classification of Diseases (ICD) to standardize medical records. ICD-10 is an update that reflects changing needs in medicine. The code offers increased detail and flexibility. However, implementing the code presents medical establishments with several challenges. The biggest challenge is finding common ground between the two frameworks. How ICD-10 Impacts Healthcare A presentation published by the Centers for Medicare and Medicaid Services explains that the World Health Organization created ICD-9 in 1979 to reflect current medical advances and establish universal coding procedures. [1] The system outlines the diagnoses, procedures and terminology used by caregivers. Medical organizations...
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...CD-10CM/PCS was mandated by CMS to take effect on October 1, 2014. Both ICD-10CM and ICD-10PCS include better detail, changes in terminology, and also expanded concepts for injuries, laterality, and other related factors. ICD-10CM has many structural changes from ICD-9CM. The differences are: ICD-9 has approximately 13,000 codes that are V.S. ICD-10 has about 68,000 codes and are 3 3 to 5 digits. to 7 digits long. ICD-9 first digit is either E or V or numeric ICD-10 first digit is alpha; 2nd and 3rd are numeric; 4th thru 7th are either ICD-9 lacks detail...
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...Introduction to ICD-10-CM/PCS The World Health Organization (WHO) is the entity that owns and publishes the International Classification of Diseases (ICD) system (The World Health Organization (WHO), 2013). The United States made modifications to this classification system and in 1979 implemented the use of ICD-9-CM. Since that time healthcare worldwide has evolved and the need to collect more detailed information regarding the diseases and conditions that effect world’s population has become a high priority. Due to this evolution, the ICD-9-CM system has become outdated and can no longer accommodate our needs. Effective October 1, 2014 the United States will implement ICD-10-CM/PCS for use across the nation. Initially we will cover ICD-10-CM and then address ICD-10-PCS. ICD-10-CM is the classification system to be utilized to record diagnoses identified and treated in both the acute care setting as well as the ambulatory setting. There are various differences between ICD-9-CM and ICD-10-CM and we will highlight several of those differences today. One difference between the two coding classification systems is the number of chapters. ICD-10-CM consists of twenty-one chapters as compared to the seventeen chapters in ICD-9-CM. There are approximately 68,000 diagnostic codes in ICD-10-CM as opposed to the 14,000 in ICD-9-CM (DeVault, Barta, & Endicott, 2012). The length and structure of the codes in ICD-10-CM vary greatly from ICD-9-CM. We have...
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...assignment of data codes. I results I wish to accomplish are the following: The Changes between ICD-9 and ICD-10 code sets. Differences between ICD-10-CM and ICD-10-PCS code sets. How ICD-10 coding could affect patient encounters. How the transition will affect departments. Regulatory requirements. Quality Improvement. Clinical Documentation Improvement. The challenges and barriers of ICD-10-CM/PCS coding transitions. Create a checklist for the staff. The font or typeface I will use or script-like fonts around 14, in bold those typically work better as heading fonts rather than body text and 12 for the body. I use of visuals communication would help me effectively deliver my message on the important issues with documentation and with the pictures and graphs, showing gains and loss of loss revenue would help them understand what is required for compliance and increase revenue. I will also show the standard required to be in compliances with The Joint Commission rule and regulations. The reason for my choice for training materials because is easiest way too explained and train the staff with all the new changes. These training sessions will be workshops and departmental in-services with custom design to fit each service needs. My training or transition would start with and introduction to explained in detail the new system of ICD-10 The ICD-10 Transition The ICD-9...
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...epidemiological data collection. Discussions will describe disease classification, analyze reasons why it was selected, and explain how it is applicable to work, review the benefits of the systems and also discuss the negative draw backs of the system. To begin discussions will focus on defining disease classification structures. Disease Classification Structures Disease classification structures are essential to health care. The International Classification of Disease Ninth Revision (ICD-9) is a classification system developed by the World Health Organization (WHO) to categorize diseases. ICD-9 collects data on disease and in the United States the ICD-9 is used to categorize procedures as well. The ICD-9 is also used to analyze mortality and morbidity rates worldwide. According to Kurbasic et al, “the basic concept of ICD is founded on the standardization of the nomenclature for the names of diseases and their basic systematization in the hierarchically structured category” (Kurbasic et al, p. 160, 2008). The ICD is used as the standard...
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...appointment was over you received a paper with a lot of different codes on it? Then were you asked to give it to the front desk on your departure? Well this is where the ICD comes into play. These codes are used to tell the insurance company what procedures or test were performed on you during this visit. The International Classification of Diseases 10th Revision (ICD-10) is a major change in how healthcare information will ultimately be used in documenting and collecting information both, worldwide and in the United States. Many countries have used the ICD-10 for many years now. The ICD-10 plays an essential part in everything related to the practice of medicine, from quality measures, research and claims that are processed. From the beginning there were concerns that are associated with managing and implementing the ICD-10 code set, preparing and realizing that getting through this transition would be the first of many. For me knowing that the classification of diseases will make doing paperwork easier, I can truly appreciate the ICD-10. With the constant changes that occur in health, we need to constantly improve the way we provide care to patients. The international Classification of Diseases (ICD-9) received its name because it was the ninth revision. The World Health Organization or WHO as it is known implemented ICD-9 more than 35 years ago. It is now considered to be very obsolete and very outdated. A revision was needed due to the fact...
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...Analysis, SWOT Analysis, Gap Analysis, Risk Analysis, Disaster Recovery Planning, Testing and Project Planning. ▪ Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process. ▪ Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims 837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications. ▪ Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes ▪ Proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio ▪ Experienced in handling Change Management...
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...If outdated codes are submitted on claims, providers and health care facilities will incur administrative costs associated with resubmitting corrected claims and delayed reimbursement for services provided. The Official ICD-9-CM Guidelines for Coding and Reporting, the Official ICD-10-CM/PCS Guidelines for Coding and Reporting are rules that were developed to accompany and complement the official conventions and instructions provided in the classification system. They are based on coding and sequencing instructions in the classification system, but provide additional instruction. Adherence to these guidelines when assigning diagnoses and procedure codes is required under HIPAA. The guidelines that the DHHS, CMS and NCHS prepare for coding and reporting are: Structure and coding conventions, Chapter-specific ICD-9-CM or ICD-10-CM coding guidelines, Selection of Principal and additional diagnosis and procedures for inpatient settings and outpatient coding and reporting. The guidelines are approved by the AHA, AHIMA, CMS and NCHS that comprise the cooperating parties for the ICD-9-CM and ICD...
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...Classification Systems Catrina Lemus American International University April 3, 2011 Abstract The following paper will be discussing the 4 main steps to ensure that the ICD codes are accurate. This paper will also be discussing the four steps that are necessary to establish the proper ICD-9-CM code. There are many ways that this paper will explain what is right to do and gives you a good source through a book that you can just gather all your information from. Step-by Step Medical Code Book by Buck is such an incredible book to get your sources from. ICD-9-CM code means International Classification of Disease, 9th edition. This is a standardized classification of disease, injuries and causes of death, by etiology and anatomic localization and anatomic localization and codified into a 6 digit number. When given any of these symptom assigned number’s this allows many clinicians and many involved people that have the same common language with in the medical field. The ICD-9-CM has been used in this country since 1973 for morbidity applications. This will help continue the hospital or anyone dealing with medical to be organized and just improve more and more. There are 8 steps to follow to have an accurate coding system. We are going to discuss the top 4 that are important. First one is to identify the main term in the diagnostic statements meaning you would to make sure that you have the correct code. Always do a double check when finding the correct code. The second...
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...Definition of Terms Shaun W. VanDevender HCS/533– Health Information Systems Professor Derrick Dugeon September 1, 2014 Definition of Terms Technology has greatly changed health care in many different ways. This change has been gradual, progressing over several years; it has been very profound, nevertheless. Understanding these changes is important for experienced health professionals and newcomers alike. The following paragraphs will provide some definitions for the following important abbreviations: AMR, CMR, CMS, CMS-1500, CPT, DRG, EPR, HL7, ICD-9, and UB-92. In addition, the importance of each term will be discussed. AMR According to Techtarget.com an ambulatory medical record (AMR) is an electronically stored file of a patient’s outpatient medical records, which includes all surgeries and care that do not involve being admitted to a hospital. An AMR is similar to an electronic medical record (EMR) but while EMRs keep track of inpatient care (surgeries and care that require spending overnight or longer in a hospital), AMRs only apply to medical procedures and care that do not result in an overnight stay in a hospital or that are given in non-hospital settings such as urgent care clinics, physicians’ offices and at-home medical care. AMRs assure that patients receive appropriate care. AMRs provide clinicians information they need to get a complete picture of the patients health. In addition, consumers can use the health information in the AMR to better communicate...
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...provider must be a provider of health care services and can no longer be a billing service or clearinghouse. 4010 to 5010 Change: Billing Provider field can no longer state the information of a billing service or clearinghouse. Information must be that of a health care service provider. Q: Can the Billing Provider address be a PO Box or Lock Box? A: The billing provider address must be a physical street address and can no longer be a PO Box or Lock Box. In ANSI 5010 format, there is a Pay-To address in addition to the physical address if the provider prefers to send payments to another location. This Pay-To address can be a PO Box or lock Box. The 5010 Pay-To address is different than the 4010 Pay-To address. The 5010 Pay-To address will have the same name as the physical address provided. Providers sending 4010 files should change the Pay-To name to match the Billing provider name to be compatible with 5010. The Pay-To address no longer refers to a different person or organization. 4010 to 5010 Change: Billing provider must have a physical address. If using the Pay-To address for PO Box or Lock Box, the NPI or Tax ID must match the Billing provider's NPI or Tax ID or claim will be rejected. Q: What is the requirement pertaining to 9-digit zip codes? A: The provided zip codes in the Billing Provider address, Facility address, and Pay-To address must be a valid 9-digit zip code as stated per the United States Postal Service. To locate your organization's valid 9digit zip code, visit...
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...Business Analyst with over 6 years of professional experience in Software Development Lifecycle (SDLC) and business reengineering process, offering extensive experience in healthcare domain. Areas of expertise include HIPAA compliance ANSI X12 4010 to 5010 and ICD 9 to ICD 10, EDI transactions and Claims Adjudication process. Experience with FACETS and NASCO configuration, coordination of benefits (COB), Medicare and Medicaid programs; strong interpersonal communication, writing, presentation and collaboration skills. QUALIFICATIONS SUMMARY | | * Proven track record of delivering cost-effective, high performance technology solutions to meet the constantly changing business needs. * Demonstrated experience in gathering requirements and developing detailed functional specifications through JAD sessions, interviews, observation, and on site meetings with SME, business users & development teams. * Adept at writing business requirement documents (BRD), functional requirement documents (FRD), system requirement specifications (SRS), system design specifications (SDS) and other project related documents. * Expertise in conducting gap analysis, SWOT analysis, risk analysis, root-cause analysis and change management assessment. * Proficient in business process reengineering and Software Development Life Cycle (SDLC), including analysis, design, development, testing, and implement of software applications, employing Rational Unified Process (RUP), Waterfall...
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...Intro to task two: The Indian Health Service (IHS): The IHS is a health care system for nearly 2 million American Indians and Alaska Natives who belong to the 566 different, federally recognized, tribes in 35 states. 1 IHS is an agency within HHS, which is the Department of Health and Human Services. 2 The Indian Health Service was established in 1955 taking over from the Bureau of Indian Affairs. It is based on Article I, Section 8 of the Constitution and the relationship developed from numerous treaties, Executive Orders, and Supreme Court decisions 3. The IHS is the primary health care provider for the American Indian people 4, and it’s dedicated to raise their health and well-being to the highest level. Health Information Exchange(s): A Health Information Exchange is the virtualization of healthcare information electronically, and access to said information exchanged between HIE members. This data spans across organizations within a community, or hospital system, or even whole regions. HIEs facilitate transmitting protected health information to other organizations and government agencies according to national standards. HIEs often include collaboration among physicians, home health, nursing homes, hospitals, and mental health facilities. 5 Federal Employees Health Benefits Program: The FEHB Program is for Federal employees present and retired as well as their survivors. Members have the widest selection of health plans in the country. With the ability to choose...
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...Introduction: There are a lot of abbreviations used in the United States health care delivery systems. A list of some of these abbreviations that are used by physician’s offices, hospitals, nursing homes, and other ambulatory care services are listed in this paper. 1. AMR - The definition of an Automated Medical Record, otherwise known as an electronic medical record, has been set forth by the 2003 IOM Patient Safety Report as the: • "collection of electronic health information for and about persons" • "provision of knowledge and decision-support systems [for] support for efficient processes for health care delivery" • "electronic access to person-and population-level information by authorized users" ("Definition Of Automated Medical Record", 2012). 2. CMR – According to "Mortality Frequency Measures" (2012), Crude Mortality Rate. The Crude Mortality Rate is the mortality rate from all causes of death for a population during a specified time period. • Mortality rates measure the frequency of occurrence of death in a defined population during a specified interval. • There are several specific kinds of mortality rates, but we will focus only on the ones that are used most often in infectious disease epidemiology. • To calculate a simple mortality rate, we need to know the number of deaths in a given population during a specified time period, and the size of the population in which the deaths occurred...
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...Definition of Terms Mathew V Kurian HCS/533 Definition of terms Every branch of science uses certain terms with specific meaning peculiar to itself The student of that branch has the responsibility not only to familiarize himself or herself with these terms but also has to have a thorough understanding as to what those terms are meant to be in order to master that field of study. In order to master the study of Information System in Health care, a thorough under-standing of the following terms are very important. AMR. The Automated Medical Record. The Automated Medical Record is a clinical information system with powerful facilities for querying and decision support. Automated Medical Record is the beginning of using electronic medium for the purpose of communication between health care providers, and between patients and health care providers and vice versa. Automation of medical record was originally intended to promote timely billing and securing prompt payments, but it came to stay as the most beneficial development for the patient in the scheme of delivery of care. Lack of proper and complete medical record may be the most important reason for the medical error in the treatment process. CMR. Computerized Medical Records. Computerized Medical Records are the digital counterparts to patient medical records kept in paper files and folders in health care offices. They are, in essence, an electronic version of the same medical records...
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