HCM-345 Short Paper(M4)

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School

Southern New Hampshire University *

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20EW2

Subject

Health Science

Date

Jun 10, 2024

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docx

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3

Uploaded by MasterCrownRook6

Oshea Penn HCM-345 Short Paper March 27, 2022 Short Paper For healthcare organizations to be able to perform properly they must adhere to all medical, billing, and coding regulations. The billing and coding regulations are one of the most important pieces to the reimbursement process. Without the proper ICD-10 codes, CPT codes, or Healthcare Common Pro codes (HCPCS) can put a delay in the reimbursement process or results in denied claims which then means that organizations or providers are not getting reimbursed. Icd-10 codes are the key codes that describe a patient’s conditions or injury. Healthcare organizations and providers use these codes to help with the billing process. Icd-10 codes cannot only tell the condition of the patient but also the location or severity of the patient’s injury or their symptoms form a recent office or emergency room visit. Cpt codes and Hcpcs codes go into more depth about what the provider did during the visit. “Current Procedural Terminology (CPT) codes and the Healthcare Common Procedure Coding System (HCPCS) make up the procedure coding system” (CycleIntelligence, 2022). Cpt codes also describe the services rendered during an encounter with a physician, these codes also help with the billing process because it accurately shows what the patient had done. “Many HCPCS and CPT codes overlap, but HCPCS codes describe non-physician services, such as ambulance rides, durable medical equipment, and prescription drug use. CPT codes only indicate the procedure, not the items a provider used” (CycleIntelligence, 2022).
These prospective payment systems have a major impact on operations especially if the guidelines are not followed accurately. When these regulations are not followed this leads to a delay in insurance companies, healthcare organizations, and providers not being reimbursed in a timely manner. This can also lead to the patient having to pay out of pocket costs if claims were denied. These codes are crucial when billing does start the claim because one cpt code could be cheaper than another and if the right codes are not in the chart a patient or patient’s insurance could be getting charged more than what they should actually have to pay, which too will put a delay in the reimbursement process if not caught ahead of time.
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