...Project Reflection As I undertook to study this course, I was apprehensive and worried about Part 4 concerning the project portfolio. At first I had the perception that common diagnostic coding auditing processes are complicated to understand and to use in the medical profession.Until I begin handling part 4 of this project; it is when I realized that medical coding system is a process of assigning numeral values to medical procedures and diagnoses. It is when that I developed an interest in interrogating the medical coding system deeper though it sounded straight forward. This project has enlightened me that in all healthcare settings medical coding system is crucial as it used to develop data for both inpatient and outpatient services. I am also made to be accurate in diagnostic coding and auditing processes, as the success of all medical procedures and diagnoses is dependent on the data from these systems. My awareness of medical coding system, therefore, has been increased throughout this course. For instance, I now know that all medical assessments, quality review and physician reimbursements are all based on medical coding system. I also know that coders, like any other professionals, can get caught in a rut.Such a circumstance may lead to the formulation of bad coding habits with errors that are detrimental to the accuracy needed in this profession. I will apply the knowledge I have gained throughout this medical course to identify areas that I may...
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...The healthcare industry has evolved in the technology age from medical devices and advanced surgeries to the implementation of ICD-10 and the electronic health record. Progression is not only inevitable for the healthcare industry, but also for society as a whole. This results in increased workflow to ensure continuum of care is being met. A major concern that the health information management (HIM) industry is facing is inaccurate clinical documentation which contributes to coding errors. This causes increased claims rejection which can affect a facility’s revenue. As part of the ICD-10 transition, there is an expectation of high standards in processing medical records while enduring the massive amount of workload that comes along with thousands...
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...Definition of Terms Vanessa Salgado HCS/533 October 15, 2012 Eric Rios Definition of Terms ICD-9- International Classification of Diseases, Ninth Revision, Clinical Modification- A coding system to classify disease data by disease information or procedure information for clinical information; The coding system assist with reimbursement of services provided by facilities. • The most important aspect of ICD-9 coding system is it defines disease in category allowing medical personnel to determine diagnosis, disorders, and procedures incorporating patient data and can assist in utilization process. CPT- Current Procedural Terminology- CPT is another coding system to document medical services, surgical procedures, and diagnostic procedures. CPT codes are HCPC codes that can identify what has been done to a patient to assist in the diagnosis and prognosis of the patient by physicians, billers, coders, and administrative personnel. • The importance of CPT codes is it is a uniformed coding system for medical personnel to document accurately and maintain records for billing and diagnostic purposes. CMS- Centers for Medicare and Medicaid Services- An agency within the Department of Health and Human Services that administers the Medicare and Medicaid program and standards for HIPPA. • The importance of CMS is it provides the different standards that Medicare and...
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...April 14, 2013 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...
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...Health Care Delivery Systems Ja*** Sta***** 04/12/2011 Health Care Delivery Systems Exam Paper The challenges faced in our most extreme healthcare facilities The Dialysis, Correctional, Mental Health, and Substance Abuse health care facilities are four very diverse settings in many ways. Yet in others they are similar. They represent many of the aspects of society that are orphaned, discarded, or swept under the rug, challenging both the caregiver and patient alike. Each represents an environment of extremes. Professionals must exercise the highest degree of vigilance in order to successfully provide patients with the care they need under the unique circumstances that each environment presents. In many ways each one of these facilities has a captive cliental with little or no choice but to be compliant or face dire consequences. In the dialysis setting compliance is enforced by the simple fact treatment is necessary to maintain their life. The correctional setting is harsh and restrictive with many imposed limitations, presenting the potential for serious health risk to inmate and care provider alike. The mental health facility is challenged by the lack of stability within the mind of the patient who is viewed as having “disordered thinking” presenting healthcare providers with the challenge of helping someone who is unable to follow orders or unwilling to even be treated. Substance abuse facilities have a patient base of substance dependent clients who present many...
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...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 that will explode into a list different codes use for supplies that were use. Then there are some that may use the charge code (CDM) which breaks it down into six common elements, charge code, item description, department number, Charge/price, revenue code, and CPT/HCPC codes. “For most healthcare providers medical claims fall into one of two types: CMS-1500 and CMS-1450 (UB-04). The...
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...Medical coding specialist play an important role in the healthcare field. Using alphanumeric diagnosis codes they communicate important information about medical conditions and treatment. Coders translate medical terms into a specific format, allowing information to be send accurately between the physician and the insurance carrier. Correct coding ensures that the patient's medical conditions are recorded properly, verification of the provider’s services and appropriate reimbursement by the payers for their services. Additionally, codes are used by public health agencies to track public health threats, provider performance and to identify potential areas of financial or medical fraud within the healthcare industry. When coding is done properly, patients, providers and payers all benefit. Medical coding specialists work in a variety of settings, both clinical and non-clinical. Clinical settings may include hospitals, surgical centers, physician offices, dental offices and home health agencies. Coders who work outside the clinical setting may work for insurance companies, independent billing and coding services and public organizations. Most Coding specialist work full time in a business office environment coding clinical data from patient charts. They use a variety of resources to code correctly for services, supplies and diagnosis, including ICD and CPT codebooks. Becoming a coding specialist really has no mandatory requirements for employment, success as a coding specialist...
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...Terms Michelle D. Dodd HCS/533 - HEALTH INFORMATION SYSTEMS February 09, 2015 Kevin Lett University of Phoenix Introduction This paper will attempt to give a brief definition of the follow terms listed below, while at the same time providing a personal view of the most important aspect of each definition. * AMR * CMR * CMS * CMS-1500 * CPT * DRG * EPR * HL7 * ICD-9 * UB-04 AMR There are a few meanings of the acronym AMR in healthcare like, American Medical Response, Active Metabolic Rate, Ambulatory Medical Record, just to name a few. The one that stands out the most from a personal view is American Medical Response. This service provides emergency response, and dispatch services, non-emergency transport services and air ambulance services. The most important aspect of this service is providing services to the medically ill, severely injured, persons that are immobile and need assistance with getting to the hospital to receive proper medical attention. Without this service, hundreds of people can be in danger of losing their lives or the lives of a loved one. CMR CMR is an acronym for Computerized Medical Records. Computerized Medical Records are the digital counterparts to patient medical records kept in paper files and folders in healthcare offices. For healthcare professionals, the benefit of using computerized medical records is helping to save time and money. This system prevents patients from waiting long unnecessary periods...
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...Summary Numerous healthcare organizations are investing in the use of Epic Electronic Record (EHR) solutions to improve quality of patient care and efficiency. With the growing reliance on digital records for everything from patient test results to medical records to billing and HIPPA reporting, high level of availability Epic HER environment has never been more important. Epic creates and provides integrated software to health care organizations so they can take better care of patients by improving outcomes, enhancing the patient’s experience, and supporting research. All of Epic’s applications are built on a single database, providing an integrated solution that supports patient care and continuity throughout hospitals, clinics, and physician offices. Using these applications, health care organizations and professionals can access the appropriate patient information instantly whenever and wherever needed. Epic is privately held health care software company. In 1979 it was founded by Judith Faulkner. The company headquarters was in Madison, Wisconsin, but in 2005 the company moved to Vernon, Wisconsin (Epic, 2013). The software’s market is largely healthcare organizations, and it is an interesting suite of healthcare software centered on a MUMPS database. Epic System provides the healthcare management software that integrates financial and clinical information across the organization in one database. The systems software includes scheduling...
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...is a small free standing clinic with under 25 beds. * Smiles clinic has on staff one IT/telephony expert, two coders and one billing administrative clerks. * IT/Telephony expert * Coding experts: * Submit claims in accordance with government regulations and private payer policies, follow-up on claim statuses, resolution of claim denials, appeals submission, posting of payments and adjustments, and collections management. * Coding professionals are expected to support the importance of accurate, complete, and consistent coding practices for the production of quality healthcare data. * Coding professionals in all healthcare settings should adhere to the ICD-9-CM (International Classification of Diseases, 9th revision, Clinical Modification) coding conventions, official coding guidelines approved by the Cooperating Parties,* the CPT (Current Procedural Terminology) rules established by the American Medical Association, and any other official coding rules and guidelines established for use with mandated standard code sets. Selection and sequencing of diagnoses and procedures must meet the definitions of required data sets for applicable healthcare settings. * Coding professionals should use their skills, their knowledge of currently mandated coding...
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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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...Healthcare IS Definitions Termika R. Stone HCS/ 533 Health Information Systems May 30, 2011 Professor Linda Mesko The health industry has been under major construction in its efforts to catch up in this age of technology. These efforts are referred to as Health information technology (HIT). HIT imparts the architecture to explain the complete management of health information throughout the various computerized systems. It 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...
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...Physician Reimbursement Case Case Study Discuss the general differences between facility and nonfacility rates. Discuss the MS-DRG system for hospital inpatient services. Include in your discussion the history of the MS-DRG system and the need for the updated system. There are two types of bills used in healthcare. Which type of bill is used for physician services? Which type of bill is used for hospital services? The place of service can greatly affect reimbursement, depending on the type of service provided and the location. The reason being is that Medicare typically reimburses physicians based on a method called Relative Value Units (RVUs), which has three components: work, practice expense, and malpractice. Procedures that can be performed in either a facility or non-facility setting have different practice expense RVUs, depending on the place of service. Therefore, the practice expense is a major component in rate determination, because place of service is part of this practice expense component. The practice expense component includes rent/lease of space, supplies, equipment, and clinical and administrative staff expenses. In a general sense, facilities are hospitals, skilled nursing facilities, nursing homes, or any other place that bills for Medicare Part A. Some physicians work out of a hospital owned facility, meaning that they are employed by and work in a facility owned and billed for by a hospital, and those physicians would be billing based on the facility...
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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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...Healthcare Terminology As we begin this course we must first understand commonly used terminology in order to fully gain appreciation of this information. This writer will define the terminology provided with required and pertinent information with the goal of the reader becoming familiar with said terms. This writer will offer opinion on the most relevant and pertinent aspect of each term. By offering a definition of these terms throughout, it is this writer goal that by the time of the conclusion of this paper one will be well versed in said terminology and have a better understanding of them. MAR translates to Medication Administration Record. At the earliest point the MAR was utilized through paper and each medication was initialed as given leaving much room for error. A quarter of all Americans have received, or know a family member who has received the wrong medication from a healthcare professional. (Cousins, 1998) A survey showed the 61% of Americans were “very concerned” about being given the wrong medicine. (Cohen, 1999) The e- MAR has created a new path for the healthcare field to take. A path that institutes the "5 Rights" that nurses institute while administering medication. With the electronic MAR it reduces the chance for errors. Errors will however occur for 2 reasons in this writers opinion. One, due to the fact that no system computerized or otherwise is 100 % failsafe, and two because some staff will click...
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