...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 holder, (Health Information Technology is an Associate’s degree) which provided the foundation of knowledge for her job. Her specific expertise was gained through actual...
Words: 1247 - Pages: 5
...Physician Office CHAPTER OUTLINE Patient Flow in the Physician Practice Step 1. Pre-Visit: Appointment Scheduling and Information Collection Step 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...
Words: 12974 - Pages: 52
...Dennis Quaid’s newborn twins, and those affecting neonates in an Indiana hospital. The Failure Mode Effect Analysis (FMEA) is a proactive approach to error prevention. Implementation of an FMEA system would serve as a crucial method that will help to recognize potential failures of a product or process before adverse events occur. FMEA can help identify where the use of technology can be implemented to facilitate the reduction of medication errors, especially pertaining to heparin as in this case. Studies have shown how technology, such as computerized heparin nomagram system (HepCare), smart pump infusion technology, computerized physician order entry (CPOE), and the bar coding system, can reduce medication errors. Expanding nationwide awareness of these methods should result in a significant decline of medication errors. Introduction Errors are unavoidable in today highly complex and technologically advanced medical treatment facilities and hospital. Recent studies have shown that over 1.3 million people suffer from unintended injuries in United States hospitals as a result of medical errors. As hospital medicine becomes more complex, the frequency of medical errors is increasing. For instance,...
Words: 3378 - Pages: 14
...OUTLINE Patient Flow in the Physician Practice Step 1. Pre-Visit: Appointment Scheduling and Information Collection Step 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...
Words: 12974 - Pages: 52
...minutes of practical sessions was delivered which was a combination of lecture and practice sessions using audio-visual aids. 4. Each candidate filled a confidence rating sheet prior to the course. 5. Each candidate was exposed to up to four scenarios, covering; breaking bad news, explaining a disease process, talking to an angry relative and a medico-legal issue. 6. The candidates were marked on the standard MRCP UK examination assessment sheet with slight modification of the marking system as explained above. 7. Each assessor wrote his/her feedback on the sheet along with the marks and data to be collected. 8. Individual feedback was given by the course coordinator. 9. Collective feedback was given to the whole group at the final stage of study and the course assessment questionnaire was...
Words: 1090 - Pages: 5
... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi Chapter 1: The Basics What is a bar code? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 How can you benefit from bar coding? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Tracking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Inventory management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Validation ....
Words: 29360 - Pages: 118
...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....
Words: 497 - Pages: 2
...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...
Words: 1177 - Pages: 5
...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...
Words: 1818 - Pages: 8
...their children. Parents as they stated have always been the core in making sure their children achieve a good glycemic control (Dashiff, Riley, Abdullatif & Moreland 2011). The researches made an additional argument in support of their study by stating that there were numerous literatures from the prospective of the adolescent about their parents but that knowledge about parents’ feeling and their behavior is lacking (Dashiff, Riley, Abdullatif & Moreland p.304). The significance of this study, to nursing or health care lies in our nursing code of ethics. The code of ethics 2.1 Primacy of the patient’s interest states ‘The nurse’ primary commitment is to the recipient of nursing and health care services-the parent-whether the recipient is an individual, a family a group, or a community. Nursing holds a fundamental commitment to the uniqueness of the individual patient; therefore, any plan of care must reflect the uniqueness” (2001) American nurses association. As nurses and health care providers, our sole responsibilities are to those we serve, our patients such as the cohort in this study, families and the community. One of the most important aspects of conducting a research study is to clearly state the purpose of the study. In this study on P 304 the authors clearly stated that the...
Words: 1301 - Pages: 6
...Coding, capacity and duration of memory Coding – the format in which info is stored in the various memory stores. Capacity – The amount of info that can be held in a memory store. Duration- the length of time info can be held in memory STM – coding is acoustic Capacity between 5 and 9 Duration between 18 and 30 seconds LTM – coding is mainly sematic Unlimited capacity Stores memory up to life time Multi store model – representation of how memory works in terms of three stores – sensory register- STM – LTM Describes how info is transferred from one store to another , how it is remembered and forgotten Multi- store model Atkinson and Shiffrin’s ( 1968 , 1971) Three stores Sensory register Stimulus from environment will pass into sensory register Main stores are iconic memory ( visual memory ) ( coded visually ) Echoic memory ( sound memory ) ( coded acoustically ) Memory lasts only briefly duration is less than half a second High capacity Key processes is paying attention Short term memory limited capacity capacity is between 5 and 9 items info is coded acoustically lasts about 30 secs unless rehearsed maintenance rehearsal – occurs when we repeat material if rehearsed long enough it will go into the LTM Long Term Memory capacity is unlimited memory can last many years When we want to recall memory it has to be transferred back into STM by retrieval. ...
Words: 1220 - Pages: 5
...1995). because of the relatively high proportion of errors and the lack of success preventing them, error reduction strategies targeted at the administration stage High rates of preventable medication errors have been repeatedly reported in studies in the medical literature (Bates et al., 1995; Leape et al., 1995; Flynn et al., 2002; Kanjanarat et al., 2003). It is difficult, however, to cite a single number to define the extent of the medication error problem due to differences in institutions, study methodologies, error definitions, and other variables. On the high end of estimates, one study that compiled data from 36 institutions reported 19% (~1 in 5) of the medication doses studied over a 4-day period involved medication errors (Barker et al., 2002). These errors included wrong time (43%), omission (30%), wrong dose (17%), and unauthorized drug (4%). The number of these errors deemed potentially harmful adverse drug events (ADEs) was 7%. A comprehensive review of medication error studies cited in the Institute of Medicine (IOM) 2000 report on errors in the U.S. healthcare system suggests that preventable ADEs, i.e., harmful medication errors, occur in ~1% to 10% of hospital admissions. The IOM report further estimated that 770,000 patients are injured and ~7,000 die each year due to medication errors. An estimated 28% to 95% of ADEs can be prevented (AHCPR, 2004) The added costs associated with treating medication errors can be very high (Classen et al., 1997;...
Words: 1574 - Pages: 7
...Introduction Palliative care (PC) provides a better comprehensive health care for patients with cancer and their families. Supportive care, pain management and symptom control at the end of life are valuable and common services provided by the PC team (World Health Organization [WHO], 2002). However, there are many challenges and barriers for PC in developing countries such as: health care and public literacy about PC, opioid phobia, policies and regulations to access and prescribe opioid, limited resources and adequate education and training (Bingley & Clark, 2009). The presence of these problems plays a major role in providing suitable and accessible symptom management for many oncology patients. In Saudi Arabia, between 2007 and 2011,...
Words: 2454 - Pages: 10
...cited in APA format. Your response should be three (3) to six (6) pages in length; refer to the "Assignment Format" page for specific format requirements. This written assignment has two parts and involves combining the case studies from lessons 1-4. For each of the case studies, you are responsible for selecting the appropriate case at the end of the applicable chapter and response to the question. In each of the cases you will respond as if you are the hospital administrator. For part 1 of this written assignment, please see case studies relating to lessons 1-4 below. Please combine your response to these case study questions into part I of your written assignment. Part I Lesson 1 Case Study 1. Better Service to Current Patient Population You are the administrator of a 250-bed hospital. A recent report from the county tells you that the population within a 25-radius of your facility is getting younger - the median age in the area has decreased from 35 years of age to 29 years of age. This was an expected impact of the new state university campus that has opened about five miles away. What do you need to review and analyze to ensure that you can provide the services required by this changing population in your area? Lesson 2 Case Study 2. Using Statistics to Support Expansion Plans Evaluate the data from the Agency for Healthcare Research and Quality (AHRQ) Data & Surveys (www.ahrq.gov/data) shown in Figure 2-8 in your textbook. After reading the statistics...
Words: 770 - Pages: 4
...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. 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...
Words: 1385 - Pages: 6
