...History and Future Of Medical Coding and Billing John F. McMahon BU480, Central Methodist University Abstract Medical coding and billing affects everyone during their lifetime and yet the regulations of medical coding and billing are extremely complex. Examining the history, evaluation, and effect of new regulations and their cost shed light on an already complex industry. We will review government regulations, technological advancements, and requirements that providers will face in the near future. We will examine our current systems and how they evolved through time and what they may be in the future. We have reviewed articles from the Medical Billing and Coding Association, the Department of Human and Health Services as well as the Office of the Inspector General. We will review the different types of insurance, how they each affect the process of medical coding and billing and then see what the future will be. Finally we will review what steps we have taken that has allowed a government to be so involved in our healthcare decisions. Thesis Statement Medical Coding and Billing has evolved to a point that it affects everyone at one time or another during their lifetime and has only led to complex rules and regulations that you almost need a degree to understand. From times that Physicians bartered for their services to the government telling them what to charge and insurance companies...
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...Home Based-Medical Billing - Marketing Plan Outline 2.0 Situation Analysis Medical billing / Coding is one of the fastest growing health care jobs, The US Bureau of Labor Statistics predicts that medical coding and billing will remain among the top fastest growing occupations for many years to come. Fact is: over 500,000 practicing physicians and hospitals in the USA rely heavily on medical coders and billers for customer service, and more importantly: to get reimbursed for medical services provided to patients. (http://www.medicalcodingandbilling.com) Many Billing services currently operate to manage medical practice billing among other services offered, providing physicians with the benefit and convenience of outsourcing their billing duties to third parties in order to relieve medical professionals of the tedious and challenging work that entails medical billing and account collections. National statistics show that only about 70 percent of insurance claims, initially submitted on paper, are ever paid by insurance carriers. With the advancements of health information Systems and the increase requirement and demand for electronic submissions Claims have increased the reimbursement percentage tremendously. A survey by the American Hospital Association concluded that about 18% of medical billing and coding positions remain unfilled due to a lack of qualified candidates. Occupational trends and future outlook for Medical Billing and Coding Specialists remain at the...
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...Plan Natasha Lopez Bryant & Stratton College COMM115: Information Literacy & Research Mr. Titus February 19, 2016 Professional Plan Growing up I have always said that I wanted to be a superhero, I always wanted to help ours. Therefore, when I started looking into the types of careers I wanted to be in the medical field seemed like the perfect choice for me. Choosing a career in the medical field would give me the opportunity to help others. Now being of age and knowing what a real superhero is and those who make a difference in this world I feel I’ve made the right choice. The three careers in this field that I chose to explore further are medical administrative assistant, clinical medical assistant, and medical coding and billing. I’ve done some research and I would like to take this time to request for reimbursement for my continued education, since our company has this program. Medical Administrative Assistant A medical administrative assistant is a skilled profession that is best suited to those with field-related knowledge developed through formal training. They “must be excellent communicators and use impeccable spelling and grammar when completing professional documents or communicating in writing” (Medical Assistant Careers [MAC], 2016, Duties, Training, Outlook section, para. 1). In addition, medical administrative assistants must be highly proficient in the use of computers and common applications like word processing and spreadsheets. Medical assistants...
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...#1…Public health IN THE United States, primary care remains a medical model. This is in contrast to much of the world, where the 1978 Declaration of Alma-At a which recognized that attaining health for all also requires interaction from social and economic sectors - is considered standard. Today, there is much buzz about patient-centered medical homes, a concept that promises to transform the practice of American medicine. There is much to praise about this most recent iteration of the medical home. But the missing ingrethent in all these definitions and models remains public health. A population focus that addresses the social determinants of health is an essential component of primary health care. In the United States, such a comprehensive approach has been labeled community-oriented primary care. This model is built firmly on the Alma-Ata principles and incorporates a public health approach to health services. Community-oriented primary care organizes the delivery of health services, around a population, not simply a collection of individuals. It identifies a population - most frequently a geographically defined community - and uses epidemiology and interventions to improve community and individual health and well-being. In this model, both individual patients and the community are the foci of the delivery of health services. Primary health care stands at the intersection of personal and population health services. It requires integrating medical models of primary care...
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...and Payment Collection Step 3. Rooming and Measuring Vital Signs Patient Examination and Documentation Step 4. Patient Checkout Step 5. Post-Visit: Coding and Billing Post-Visit: Reviewing Test Results Coding and Reimbursement in Electronic Health Records Computer-Assisted Coding Clinical Tools in the Electronic Health Record Decision-Support Tools Tracking and Monitoring Patient Care Screening for Illness or Disease Identifying at-Risk Patients Managing Patients with Chronic Diseases Improving the Quality and Safety of Patient Care with Evidence-Based Guidelines E-Prescribing and Electronic Health Records Keeping Current with Electronic Drug Databases Increasing Prescription Safety Saving Time and Money LEARNING OUTCOMES After completing this chapter, you will be able to define key terms and: 1. 2. 3. 4. 5. 6. 7. 8. 9. List the five steps of the office visit workflow in a physician office. Discuss the advantages of pre-visit scheduling and information collection for patients and office staff. Describe the process of electronic check-in. Explain how electronic health records make documenting patient exams more efficient. Explain what occurs during patient checkout. Explain what two events take place during the post-visit step of the visit workflow. Describe the advantages of computer-assisted coding. List three decision-support tools the EHRs contain to provide patients with safe and effective health care. List four important safety checks that...
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...Medical Insurance Billing and Coding professional within a healthcare organization offering an opportunity for personal growth, development and; most importantly, the opportunity to contribute to the success of the organization. Qualifications: * Experienced, dependable, energetic and competent support professional. * Strong ability to interact and communicate well with individuals in all circumstances. * Possess great communication skills – orally and written – in both languages. * Excellent organizational, records maintenance and follow up skills. * Able to work independently and as a team member. * Knowledge of medical terminology and possess excellent customer service skills. Skills: ICD-9 CPT Coding | CMS-1500 | Medical Law and Ethics | Electronic Claim Submission | Anatomy and Physiology | Appointment Scheduling | Medical Terminology | Internet | Modifiers | Co-Pay Collections | Account Balancing | Claim Correction {Rejections} | UB-04 {Hospital Billing} | Insurance | Patient Charts | | Microsoft Word, Excel & PowerPoint | | Professional Experience: Children Health Center May 2011 – June 2011 Medical Biller and Coder 55 West Union Avenue, Bound Brook, NJ 08805 * Extern; acquired hands on training in a specialist’s office. * Customer service representative; verified insurance coverage for patients. * Updated, processed billing and coding of claims. ...
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...2. Patient Check-in and Payment Collection Step 3. Rooming and Measuring Vital Signs Patient Examination and Documentation Step 4. Patient Checkout Step 5. Post-Visit: Coding and Billing Post-Visit: Reviewing Test Results Coding and Reimbursement in Electronic Health Records Computer-Assisted Coding Clinical Tools in the Electronic Health Record Decision-Support Tools Tracking and Monitoring Patient Care Screening for Illness or Disease Identifying at-Risk Patients Managing Patients with Chronic Diseases Improving the Quality and Safety of Patient Care with Evidence-Based Guidelines E-Prescribing and Electronic Health Records Keeping Current with Electronic Drug Databases Increasing Prescription Safety Saving Time and Money LEARNING OUTCOMES After completing this chapter, you will be able to define key terms and: 1. 2. 3. 4. 5. 6. 7. 8. 9. List the five steps of the office visit workflow in a physician office. Discuss the advantages of pre-visit scheduling and information collection for patients and office staff. Describe the process of electronic check-in. Explain how electronic health records make documenting patient exams more efficient. Explain what occurs during patient checkout. Explain what two events take place during the post-visit step of the visit workflow. Describe the advantages of computer-assisted coding. List three decision-support tools the EHRs contain to provide patients with safe and effective health care. List four important safety checks that an EHR’s e-prescribing...
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...Healthcare Compliance and Coding Management Task 1 A. Discuss how you would carry out your various responsibilities as a coding manager by doing the following: A1. Analyze the job description for an inpatient coding position Managers should be aware of skill sets needed for an HIIM workforce, and recruit qualified staff to fulfill new job roles. Manager should review the job description each time they have a recruitment opportunity. They need to ensure the description outlines the work to be performed. It should be specific to the role of Inpatient Coder. The job description needs to include the position requirements, purpose, and all functions. It should also list the qualifications needed to be hired and successful. Sections of the description should also include education level, years of experience, specific knowledge needed, and any specific proficiency needed for the job. Be specific, before posting a job. Specification helps to minimize the wasted time and effort of the interviewer and interviewee. One of the Inpatient coder’s responsibilities would be reviewing all patient files for accuracy and recording into the computer; therefore a couple of key qualifications that should be listed would be, attention to detail and has medical terminology background. (Wilson, Jacqueline) Job descriptions are used by the manager to clearly set employee expectations for job performance. A2. Develop goals for a clinical documentation...
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...Paul Carter HCA-240 Health Care Accounting and Billing April 6, 2013 Professor York Billing Process What is the process that is utilized when producing a final bill? In which ways are pricing and charging different in health care from other industries? What are the ways that private and government insurers and payers impact the actual reimbursement process in health care? The process for producing a final bill in health care starts with the medical record and coding which are communicated to the payer to start the payment process. In 1996 the Health Insurance Portability and Accounting Act (HIPAA) designated two specific coding systems to be used when reporting to both public and private payers. The two coding are International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) and Healthcare Common Procedure Coding System (HCPCS). The ICD-9-CM provides information for diagnoses and procedures while the HCPCS just provides information in the procedure area. The next process would be the charge entry and charge master which have to do with the capture of charges for the services performed, incorrect billing and billing late charges. With charge capture can be done in two different ways paper documents or charge slips. Which is done by the data processing or the business office that identifies the services that was performed on a patient? When producing a final bill they will also sometime use the charge explosion system that will use one code...
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...Compliance and Coding Management Task 2 Western Governor’s University Compliance and Coding Management Task 2 A. Outline a HIM compliance plan that emphasizes the coding function by doing the following: 1. The necessary components of a compliance plan include Code of conduct, policies and procedures, education and training, communication, auditing, corrective action and reporting. The code of conduct is a statement or oath that establishes the intent to perform duties lawfully and ethically. The second component of a plan would include policies and procedures. The policies and procedures for coding would cover items such as how and when to query a physician, acceptable documentation sources, how to rebill a claim, usage of coding guidelines, payer specific issues, and any additional gray areas that may arise in the coding function. Education and training processes must also be outlined in a HIM compliance plan. This would need to identify the number of mandatory CEU’s for each employee, new hire training guidance and requirements, as well as physician and clinical staff educational guidelines and processes. The HIM/Coding compliance plan should also include policies and procedures that address communication, the auditing/monitoring process, any necessary corrective action steps and finally the process for reporting the coding compliance steps that have been followed and any areas identified as risks or any findings of noncompliance. 2. The HIM director...
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...Medicare Exhaust Billing Procedure Manual Project Cynthia Gause Colorado Technical University Online ENGL205-1301 Technical Writing and Speaking Phase 4IP Contents Contents 1 Phase 1 IP 2 Procedure Manual Outline 2 Phase 2 IP 3 Procedure Manual Proposal (Revised) 3 Brochure 4 Brochure Continued 5 Phase 3 IP 6 Medicare Exhaust Billing Checklist 6 Procedure Manual 7 Preparing Bill 3 Step I – Census 3 Step II – Bill Upload 4 Exhaust Billing Claim Coding 5 Step III- Xclaim 5 DDE Step IV 7 Secondary Claim Submission 8 How to submit Secondary Exhaust Claim 8 UB04 Claim examples 8 Billing Reference Tools 10 Type of Bills 11 Patient Status Codes 12 DDE Access/ Menu 13 Phase 1 IP Procedure Manual Outline Outline for Medicare Exhaust Billing Procedure Manual I. Introduction This section will provide an overview of Medicare exhaust billing and the purpose of this manual. II. Bill Uploads Upload bill and billing data in the Ram system to allow bills to be created. III. Claim Coding, and required remarks Once bills have been uploaded and created, bills need to be coded correctly and remarks need to be added to the claim. IV. Submit Bill to Medicare thru Xclaim...
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...ep 3 S te p 9 Generate patient statements Check in patients Monitor payer adjudication Review coding compliance St ep 8 S te Check out patients Review billing compliance p7 St ep 5 S tep 6 Learning Outcomes After studying this chapter, you should be able to: 1.1 Explain how healthy practice finances depend on correctly accomplishing administrative tasks in the medical office. 1.2 Compare coinsurance and copayment requirements for health Copyright © 2014 The McGraw-Hill Companies plan benefits. 1.3 Identify the key steps in the medical billing cycle. 1.4 Discuss the impact of electronic health records on clinical and billing workflow. 1.5 Evaluate the importance of professional certification and of medical liability insurance for career advancement. S te p4 Medical Billing Cycle Prepare and transmit claims 1 accounts payable (AP) accounts receivable (AR) benefits cash flow certification coding coinsurance copayment covered services deductible diagnosis documentation electronic claim (e-claim) electronic health record (EHR) fee-for-service health care claim health information technology (HIT) health plan indemnity plan managed care managed care organization (MCO) medical assistant medical billing cycle medical documentation and billing cycle medical insurance medically necessary noncovered (excluded) services out-of-pocket PM/EHR policyholder practice...
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...University of Phoenix Material Health Record Worksheet In 150 to 350 words, explain the importance of a health record. Support your explanation using your assigned readings. Personal health records can help a provider's patient better manage their care. Having important health information, for example, immunization records, lab results, and screening due dates in electronic form makes it simple for patients to update and share their records. Patients can be more engaged with their wellbeing and health care. PHRs can advance better health care by offering patients some assistance with managing information from different providers and enhance care coordination. Having an online PHR can be useful if there should be an occurrence of crises particularly if a patient is traveling. Administrative expenses can be reduced utilizing a PHR to give patients simple access to electronic prescription refill and appointment scheduling applications. With PHRs, health care staff can invest less time searching for patient-requested information and respond to patient inquiries. Use the following table to identify and list at least five key components of a health record. Additionally, include a 50- to 100-word description of each component. Support your descriptions using your assigned readings. |Component of the health record |Description | |Patient Management ...
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...Public healthcare services are administered by different regulatory authorities in the United Arab Emirates. The Ministry of Health, Health Authority-Abu Dhabi (HAAD), the Dubai Health Authority (DHA) and the Emirates Health Authority (EHA) are the main authorities. Ministry of Health and Emirates Health Authority The Ministry administers a number of federal healthcare laws, including (i) Federal Law No. 5 of 1984 (regulating the licensing and registration of physicians, pharmacists and other healthcare specialists within both public and private healthcare establishments); (ii) Federal Law No. 7 of 1975 and Federal Law No. 2 of 1996 (defining the specific requirements for establishment and licensing of public and private medical laboratories, clinics and hospitals in the UAE); and (iii) Federal Law No. 4 of 1983 (governing pharmaceutical professions and establishments and the import, manufacture and distribution of pharmaceutical products). The Ministry oversees the Northern Emirates healthcare system (the Northern Emirates include Ras Al Khaimah, Ajman, Umm al Quwain, Sharjah and Fujairah). Some of the Northern Emirates recently started establishing new healthcare institutions or reforming existing ones. Sharjah, for example, established the Sharjah Health Authority by Sharjah Amiri Decree No. 12 of 2010. The Ministry, however, still invests substantial efforts to improve the level of healthcare services in the Northern Emirates. The projects announced...
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...safeguards the exchange between government, quality entities, customers, suppliers and insurers. Health Information Technology is now viewed as a very promising agent for enhancing healthcare quality, protection and a well-organized and resourceful healthcare delivery system. This assignment has ten terms that fall under the scope of HIT and Health Information Systems (HIS) that are interconnected. Each term will be defined and a concise statement of importance will be explained. AMR • AMR (Automated Medical Records) is a term used at the early stage of electronic medical documentation. It was information retained on a customary personal computer and did not comply with legal ramifications for electronic medical records. Therefore a paper file was maintained. The computer information is used as a working file, and then pages are printed and filed in the chart (Fishman, 2005). • Important aspect of AMR is the aid of premature discovery of conditions of public health issues. For instance, seasonal respiratory illness or atypical occurrences, like bioterrorist attack that initially exhibit as respiratory symptoms. Knowledge of disease patterns in real time may also help clinicians to manage patients (Ross, L., Kleinman, K., Dashevsky, I., DeMaria, A. and Platt,R., 2001). CMR • CMR (Computerized Medical Records) was the first attempt in an automated, on-line medical record system. It contains clinical and demographic...
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