...Computer - Assisted Coding Angela Brown BINF 3301 Prof. Manger November 15, 2009 Computer –assisted coding (CAC) is a computerized tool that automates a set of medical or surgical codes, based on clinical documentation from a healthcare provider, which is used for review and validation. With the assistance of these new automation tools, coding or HIM professionals can easily translate clinical data input into useful clinical data output. Increased amounts of clinical coding is done by machines, which saves time and human participation for more complex coding cases and data analysis tasks. Factors, such as advances in natural language processing, EHR adoption, compliance issues and mandates for labor – intensive administrative reporting processes reduction, influenced the demand of CAC. Traditionally, clinical documentation (whether paper or electronic) is analyzed by a coder, translated into the appropriate ICD – 9 CM or CPT/HCPCS codes with the help of coding books or encoders and entered into a database. These new coding automation tools assists HIM professionals in translating data by automated code assignment instead of manual review and translation alone. As early as the 1950s, the technology of CAC – enabled tools, particularly Natural Language Processing (NLP), started with formal language theory. Throughout this time, technological progress was slow but technology has rapidly progressed and is constantly advancing at an exponential rate since the 1990s. Coding...
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...Job description Inpatient Medical Coding Inpatient Medical Coding job involves coding charts for patients whose treatment requires hospitalization for more than 24 hours. Inpatient Medical Coders use the coding systems ICD-9-CM, ICD-10 as well as DRG (Diagnoses Related Groups). Inpatient Medical Coding requires greater knowledge and experience because the groupings and sequencing of codes for specific diagnoses and procedures in a hospital are significantly greater. Daily tasks usually include: • Review patient histories, operations, chart reviews, consultation and discharge summaries to support codes selected for billing. • Utilize ICD-9-CM and/or ICD-10 to select the diagnosis-related group (DRG) assignments for each case. • Identify mistakes in reports. • Enter coding information into electronic billing system. Many Inpatient Medical Coders work for hospitals, although insurance companies and long-term health-care facilities may also employ inpatient coders. They typically must have at least 2 years of experience to be hired and may work at the facility or off-site in their homes. Hours vary based on the employer. Accuracy is critical in this position, as much of a hospital’s revenue depends on the correct coding of the diagnoses, procedures, and treatments administered. Coders often interact with physicians, nurses and other medical professionals in order to select the proper codes. Critical thinking and communication skills, great attention to detail and the ability...
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... b. 40%. c. 50%. d. 60%. Answer: b EMPLOYMENT DEMAND 2. The percentage of all healthcare providers who are allied health professionals is: a. 25%. b. 40%. c. 50%. d. 60%. Answer: d EMPLOYMENT DEMAND 3. The increased demand for medical billers, medical office assistants, and medical coders can be attributed to: a. the growth of managed care. b. physician practices having more responsibility for filing claims. c. the need for additional staff to file claims and work to obtain timely payment. d. all of the above. Answer: d EMPLOYMENT DEMAND 4. All of the following changes were a result of managed care EXCEPT: a. physicians having to wait 30 days or longer for payment. b. physicians having more responsibility for filing claims. c. patients having to pay for services when rendered. d. physicians having to add to their staff. Answer: c EMPLOYMENT DEMAND 5. Before the 1970s, a physician’s practice would grow based on: a. advertising and referrals. b. managed care contracts. c. consultations. d. hospital affiliations. Answer: a EMPLOYMENT DEMAND 6. Before the 1970s, a solo practice included all of the following staff members EXCEPT: a. physician. b. nurse. c. certified medical biller. d. receptionist. Answer: c EMPLOYMENT DEMAND 7. Managed care is a system in which physicians contract to participate in a health insurance network and healthcare delivery is a. at the discretion of the physician. b. provided only by...
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...Analyze the various job functions of the current staff. Coders A coder is an individual that examines patient medical records and finds any diagnoses, treatments/medicines given, diagnostic testing, and so forth and gives each of these incidences a numerical (sometimes alphanumeric) value that is universal across insurance companies to collect payment for services rendered. Inpatient Coder- An inpatient coder is an individual that initiates requests for payments and reimbursement for procedures performed on a patient during a hospital stay on behalf of the medical facility. Inpatient Coders will deal more with ICD-9(10) or Diagnosis Codes than with CPT Procedure Codes. Inpatient coding could be considered to be more complex than outpatient coding because of the vast possibilities of different diseases, encounters and procedures. Outpatient Coder- An outpatient coder is an indiviual that initiates requests for payments for procedures performed either in a doctor's office or hospital outpatient department. Any procedure performed that does not require for the patient to stay more than 24 hours is considered outpatient. Outpatient coders typically deal more with CPT Procedure codes versus ICD 9(10) Diagnosis Codes. Outpatient coders that operate within doctor's offices are usually exposed to the same codes on a regular basis which is why many inpatient coders start off in an outpatient setting. Front Office Clerk The front office clerk is a job title that can differ in many...
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...produce accurate results. You should not skip steps, every step is there for a reason. As a coder, it is your job to provide correct codes that are not close to the actual code, but codes that are the actual code. I feel that this coder’s approach is unconventional and unethical. Each step included in the process is very important to the outcome of the codes; skipping steps can affect the final results. Coding is a process that takes time and care. This is why the specialist must pay careful attention to each step, if the specialist is not willing to put in that time, then the outcome will most likely contain errors. Leaving out steps can cause many problems. It could result in problems for the coders, the medical facility, and even the patient. If the coder skips a step, he/she might produce the wrong code, which could result in other errors possibly dealing with billing or even prescriptions. The patient could receive the wrong type of treatment if their diagnosis was coded wrong; this could lead to lawsuits and even job loss. I would talk to the specialist about how they code and see if I can deter them from that path with facts. I would explain about the damage that may happen resulting from their negligence. If all of my attempts fail, I will have to report them to my supervisor because of their actions. They could seriously hurt someone or even the facility financially. The medical record is important. It pertains to a patient’s care, insurance, and history. There are four...
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...the hospital and the newly acquired clinic. In the given scenario there is currently a rural hospital and an outpatient setting. Apart from these 2, the organization has also acquired an outpatient clinical setting 50 miles from the hospital which has contracted a local lumberyard and small farm equipment manufacturing plant in town to provide medical services for injured workers. In the hospital setting there are 3 coders who take care of inpatient coding services, one front office employee who takes care of the paperwork, phone calls, release of information, and filling and retrieving of health records from various hospital departments. One of the coders also performs coding services for the outpatient setting that is attached to the hospital. In the newly acquired outpatient clinical setting there is a front office employee who takes care of the coding and billing services who is also attending a local community college to become a Registered Health Information Technician(RHIT). * Code Lookup Software – Medical Code Lookup Software is a means to reduce the time the coders have to spend to manually look for a code. “Because the coder still must search the index...
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...University of Phoenix Material Accurate Registration Worksheet In 50 to 100 words, explain each step of the medical billing cycle, using Figure 6.7 of Integrated Electronic Health Records as a reference. Your explanations must be in your own words. Step Explanation 1 Pre-registration confirms the patient’s information and helps to identity the patient to ensure the patient safety. This is an important step especial for reoccurring patients... This step also helps with verifying a patients insurance. Pre-registration gives the office ample time to answer questions before they are asked by looking into the EHR. Pre-registration also allows you to see procedures that may require prior authorization (pre-cert). 2 Establish financial responsibility- Establishing financial responsibility is knowing who owes what for a certain doctor’s visits. Once the clinic gathers the pertinent information from the patient, then the biller can then determine which services are covered and allowed under the patient’s insurance plan. Insurance coverage can differ hugely between companies, individual, and plans, The biller needs to make sure each patient’s coverage in order to create the bill correctly. This also goes for prescriptions, some insurance companies do not allow for certain types or prefer generics. 3 Check in patients- Patient check-in and check-out are pretty much straight-at the desk task. When the comes in, First time patients will be asked to fill out paper forms or...
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...Week 6 – Course Project Dinae C. Davison, RHIT HIM 435 Professor Paula Arceneaux 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...
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...noncompliance with HIPAA. * Discuss electronic medical record (EMR) and its importance. Answers: 1) The disclosure of personal information could cause professional or personal problems; patients rely on physicians to keep their medical information private. It is rare for medical records to remain completely sealed, however. The most benign breach of confidentiality takes place when clinicians share medical information as case studies. When this data is published in professional journals the identity of the patient is never divulged, and all identifying data is either eliminated or changed. If this confidentiality is breached in any way, patients may have the right to sue. 2) In the year of1996 the Health Insurance portability and Accountability Act requires all professionals and organizations to guard the privacy of their patients and customers. Individuals must provide written consent for any and all releases of medical or health-related information. Employees at all levels are required to maintain confidentiality. Similar policies have been in place for some time. This was a requirement of the Joint Commission on Accreditation of Healthcare Organizations to maintain accreditation. All confidentiality releases must identify the types of information that can be released, the people or groups that have been permitted access to the information, and limit the length of time for which the release is valid. 3) Medical billers and coders must take particular care to safeguard personal...
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...MedBill Pros Medical Billing and Claim Services What do we do? We do everything involved to get a doctor paid for their services. This is payment from the insurance company and the patient. But there is more involving the process. The medical billing process is really important to the financial health of the practice, if claims are not submitted promptly, the doctors including us, would not get paid. Submitting Claims The medical biller and coder makes sure all forms are completed and approved and enters the information into the medical billing software, including doctor’s information, patient’s information, insurance information, medical billing codes, payment information, and any special notes on the account. Medical billing codes are necessary for a doctor to be properly reimbursed for the services provided. These codes are some of many: • ICD 9 codes (and ICD 10 codes)- international classification of diseases • CPT codes- current procedural terminology • CPT modifiers- these provide additional information to payers to make sure doctors get paid correctly for services provided • Medicare billing codes- explained for provider services and hospital insurance • CDT codes (dental)- code on dental procedures • NDC drug codes- national drug codes • DRG Medicare codes- diagnosis related group • Taxamony codes- used to categorize a provider or group specialty Our responsibility as Medical billers and coders • Collect the information necessary to prepare insurance...
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...Evaluating Compliance Strategies Patricia Estrada HCR/220 November 2012 Deborah Ryan Medical billing and compliance strategies are used to bill for medical procedures and treatments. The compliance strategies are in place to prevent incorrect billing, but mistakes are still made. Answers to the importance of correctly linking procedures and diagnoses, the implications of incorrect medical coding, and how medical coding, physicians and payer fees are related to the compliance process will be discussed. It is very important that procedures and diagnosis are correctly linked together. There are certain steps to follow that help to correctly link the procedure to the diagnoses. By following the correct procedures to apply the correct codes that link procedure with diagnosis, insurance companies can be correctly billed for reimbursements. Correctly connected claims can be analyzed and to make sure charges are for medically necessary services provided to the patient. Correct claims help reduce the chance of an investigation of the practice of fraud and the risk of liability in an investigation does occur. (Valerius, J., Bayes, N., Newby, C., & Seggern, J. , 2008). If the procedures are not linked correctly to the diagnoses, then they will not be covered by the insurance company and therefor will not be paid. The major implication of incorrect medical coding would be fraud. Even though incorrect work may simply be an error, it may also represent a deliberate attempt...
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...Health Information Technician Health information technicians work from behind the scenes of healthcare. Health Information Technology is an emerging, growing field in medicine, offering many career opportunities. They make it possible for healthcare providers to better manage patient care. Working in health information technology is a great way to enter the workforce in the growing healthcare industry. A health information technician is a unique job because it doesn’t require direct patient care. They collect, organize, and analyze data used in healthcare. In hospitals, doctor’s offices, clinics, and insurance companies, they ensure the accuracy and security of medical records. The purpose of this research is to identify the requirements for a Health Information Technician in the United States. Secondary research includes a review on numerous job related websites, library research, and textbooks. The research contains the following parts: Education, Licensing and/or Certifications, Credentials, Salary Range, Job Opportunities, and Job Growth. Primary research focuses on questionnaires and surveys about this specific topic. The limitations of research were due to time management and a lack of face-to-face interviews. Education The type of Health Information Technician degree or certification depends on the desired career path pursued by the individual. A high school diploma is necessary for admission to a college level program in this field. Some individuals already working...
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...for me. My paper will inform you on the advantages of following a career in the health information technician career field. First of all, this one of the few jobs in the medical industry that has no hands on contact with patients. Another advantage is the wages that can be made and the benefits provided by employers. The last point to be made is that the employment rate is expected to grow it fastest ever in the years to come. The first advantage that will be discussed is the work environment and the different specialties. This job is done mainly inside the comforts of an office, at a desk. The majority of the work is mainly done on a computer. Even though most of the work is done on a computer there is still some work that is done over the phone and paper work that may need to be filed. A health information technician has no hands-on contact with patients what so ever. People in this field tend to work the standard 40 hour work week, with all national recognized holidays off. Another advantage is being able to choose if you want strictly work codifying patient medical records or you can choose to work as a cancer registry (Johnson, 2006). With that being said, the role and responsibilities of a Health Information Technician (HIT) also known as a Medical Records Technician include maintaining the medical information system of a...
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...Corrie Crittle HCR/220 Medical Building Process Documentation at the Front Desk: The patient hand over an insurance card, this case the patient has Humana. On the care the office manager needs to verify if a referral or pre-authorization needs to be obtained and then contact the respective Primary care physician and get his documentation. Insurance verification data and a copy of the insurance card is sent to the billing office. The billing office scans the information and saves the documents. The Scanning department retrieve the information and it sent to the appropriate departments. Pre-coders then enter the key-in codes for insurance companies, doctors and modifiers. Pre-coders also add insurance companies, referring doctors, modifiers, diagnosis codes and procedure codes. The coding team assigns the Numerical codes for current procedural terminology and the diagnosis code based on the description given by the provider. The charge team has competent individuals who would first enter the patient personal information form the information given. Also they check for the relationship of the diagnosis code and the current procedural terminology. They create a charge, according to the billing rules pertaining to the specific carriers and locations. All charges are accomplished within an agreed turnaround time, about 24 hours. The daily charge entry then needs to be audited to double check the accuracy. Claims are filed and information sent to the transmission...
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...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 fall into the trap of assuming too much. Also to avoid the tendency of not correctly scrutinizing the medical records. This knowledge will in turn assist me in overcoming superficial errors...
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