...Healthcare Compliance Assignment Week 4 Write a one page document covering the Case Study found on page 43 answering the following questions. Why is it important to use current codes and coding books? How could this error have been prevented? Would this claim have been denied? What are some of the effects of a denied claim? It's very important to use current codes and coding books. In this case study of Mrs. Cleett. If the Billing specialist hadn't checked the code before submitting the claim it could have been denied or delayed. Sometimes codes are revised and deleted. A new set of codes may tell you to code a different way. Using your coding books will keep you from over and under coding. It is also important to code from current coding books because the guidelines for a...
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...CODER INTERVIEW Like a regular business entity, healthcare facilities need continuous inflow of funds to continue existing. However, billing complexity in the health care industry is unlike all other industries. The biggest difference of healthcare from other businesses is the source of payment for services rendered: the majority of which is from a third party with pre-determined rates and strict prerequisites. Foundational to these prerequisites is the accuracy of medical coding. An interview with a coder provided fresh understanding of the coding profession. And a look into the private and government payers and insurers’ roles brings better understanding of their impact on reimbursement. MEDICAL CODING Medical Coding is the process of using standard codes in identifying medical services and procedure. This is used for billing and reimbursement from payers for services rendered. Medical code is foundational and standardized with industry-wide language. The use of the Healthcare Common Procedure Coding System (HCPCS) is mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), (Medial Billing and Coding). THE INTERVIEW I interviewed an outpatient coder of Pennsylvania Hospital. Her job includes coding for hospital out-patients and Physicians’ in-patients and out-patients. She explained medical coding is quite complex and a coder needs proper schooling and training. She is a graduate of Health Information Management, a bachelor degree...
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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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...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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...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 that are centered on...
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...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. In many cases, when a health care practitioner wants to invest in computerized medical records, paper medical records are simply scanned and entered into a medical records system. Instead of documenting patient information on paper and creating a file for every patient, electronic medical record store the information in its server (Gonzales, S.,...
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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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...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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...UNDERSTANDING MEDICAL INSURANCE KEY TERMS Step 1 S te St ep 10 Follow up payments and collections Preregister patients p2 Establish financial responsibility St 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 ...
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...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 is a difficult...
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...Healthcare Professions Case Study Your Healthcare Professions Case Study assignment assesses your understanding of various healthcare functions and professions, as well as the overall healthcare industry. You will choose a healthcare profession (preferably, one that interests you because you will be spending a lot of time researching this profession). Then, you will apply concepts from this course as well as independent research to respond to a variety of questions about the profession. Finally, you will summarize your findings in either a PowerPoint presentation or a report. The Healthcare Professions Case Study assignment is broken up into four parts, summarized below: Assignment | Due Date | Part I: Identify a Healthcare Profession | Sunday of Week 1 | Part II: Certifications, Job Responsibilities and Career Possibilities | Sunday of Week 2 | Part III: Compliance, EHRs, and Interaction with Others | Sunday of Week 3 | Part IV: Research Summary | Sunday of Week 4 | ------------------------------------------------- ------------------------------------------------- Part I: Identify a Healthcare Profession (Complete and submit in Week 1) Choose a non-clinical healthcare profession, preferably, one that aligns with your career goals after graduation. Identify your chosen profession and why you chose it. Also, discuss what you may know about this specific profession within the healthcare industry, before you actually research it. Your response should be at least...
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...Write a one page document covering the Case Study found on page 43 answering the following questions. Why is it important to use current codes and coding books? Since being in the certificate program and the associates program, it has been drilled into us to always check and recheck every code that we enter and not to guess or just assume that this code is the right one. We have to make sure that a certain code is the right ones for any procedure that is done, and that it tells the story of why the patient was being seen/treated. Common sense is usually the best way to go when you have to enter in codes on a patient and to always double check your work before you submit any kind of claim, it just looks more professional on you and your facility....
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...athenaCollector: A Medical Practice’s Premier Billing and Workflow Application In 1997, Jonathan Bush and Todd Park purchased a birthing practice in San Diego, California. When they ran into insurance reimbursement issues they began to look for existing electronic medical records (EMR) and practice management solutions to help solve their problems. They were unable to find software that met their needs so they decided to create their own program and as result athenahealth, Inc. was born. Three years later, co-founders Jonathan Bush and Todd Park introduced a billing and practice management service called, athenaCollector. In 2006, athenahealth, Inc. launched athenaClinicals, advertised as the "first economically sustainable, service-based" electronic medical records (EMR) system (“athenahealth Introduces,” 2006). In August 2008, it announced the acquisition of MedicalMessaging.net (“athenahealth to Acquire,” 2008). Today athenahealth has four main services: • athenaCollector - A web-based physician billing and practice management solution that reduces administrative red tape that allows you to efficiently assess, plan, and improve practice performance while increasing revenue (“athenaCollector,” 2012). • athenaClinicals - An electronic health records (EHR) system, delivering increased revenue, decreased cost, and more clinical control to medical practices. With flexible, web-based Certification Commission for Healthcare Information Technology (CCHIT) certified software...
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...Liability…………………………………………………………….. 2. Legal Interoperability ……………………………………………... 3. HIPAA Audits……………………………………………………… IV. Benefits of using NueMd EMR software versus the previous software …... A. Inpatients EMR………………………………………………………… B. Patient Accounting and Patient Management…………………………... 1. NueMd Case Studies……………………………………………….. 2. Partnerships and Affiliations……………………………………….. V. Summary VI. References NueSoft technologies, Inc. is a provider of web based medical and practice management software. Nue soft also known as NueMD medical software. Nuesoft technology headquarter and was established in 1993 in Marietta Georgia by Massoudd Alibaksh. The company develops and sells practice management software for physicians, practices, medical billing companies, Nusoft also known as NueMD that is a flagship product which is notable for being the first internet based. Nuemd is well known web based electronic health records software that assists and helps medical professionals with Billing, Coding, charts and sharing information with other providers with in the same institution or organization to manager medical records more effectively and efficiently. NueMD also offers automatic software updates with the ID...
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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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