Case Study: Coding Medical Necessity

I will do only the patient demographic part and the provider or someone for clinical has to complete the form. I still don't understand why Johana or any MA can complete the patient demographic part on vase of the list that I provide to them but anyway I will do that part so they can't said that our billing department don't want to cooperate on this process.I know we shouldn't not be responsable for this but we need to recovery that

Committing medical coding fraud or abuse is extremely detrimental to the healthcare industry. They both lead to higher healthcare costs and an increase in the cost needed for medical coverage. In addition, the increasing discovers of these acts are putting a very negative light on healthcare workers, including those who are not committing either act. With the medical world being so complex we often instill and great amount of trust in the persons taking care of medical billing and coding, this trust also makes committing fraud and abuse easier for dishonest people to take advantage of.

According to Chtourou (2013), a CDI program focuses on enhancing the accuracy of clinical documentation quality which requires a huge input from CDI specialists, heath information management professionals, coders and clinicians to collaborate together to review the quality of documentation reported/captured in order to ensure accuracy and complete of patient’s clinical encounter. As a healthcare provider, medical records that are incomplete or inaccurate often times, compromise the quality of care reporting and inevitably affect the clinical decision support system of the organization including the accuracy of reimbursement. This is reasonable since the CDI program has emerged as a new paradigm to meet the changing needs of maintaining a sound health record documentation across the healthcare industry (Hauger, 2014). Most of the CDI programs have to a great extent concentrated on boosting the Diagnosis-Related Groups (DRGs) installments by securing clinical documentation to support medical complications and co-morbidities (Hauger, 2014).

The most important element in becoming a Medical Billing and Coding Specialist is the training and certification need to enter the field and for advancement. You will need a program that provides an understanding of anatomy, physiology and medical terminology. This program should also navigate the three topics: ICD, CPT and HCPCS. These codes help you document the conditions of a patient and describe the procedure performed on the patient. When you have completed your training there are several certifications you can test for. The American Health Information Management Association (AHIMA) offer certification for the Certified Coding Associate (CCA). You will need AHIMA membership and an exam fee ($199- $299), a high school diploma or

HIM Personnel play an important role in the Medicare system. Medicare has transitioned from “fee for service” to providing incentive payments for providers that issue high quality care at affordable prices. In order to achieve the “pay-for-quality” incentives hospitals and health care officials must improve their documentation processes. “If it isn’t documented, it wasn’t done” is more important than ever. It is the responsibility of the HIM professional to ensure the integrity of the patient chart. HIM professionals monitor the quality of documentation and ensure all clinical documentation is complete and accurate. HIM professionals are the key to identifying process problems while keeping in mind patient safety, quality of care, and revenue integrity. Medicare requires that hospitals report quality improvement measures in order to receive payments; HIM professionals can directly impact Medicare incentive payments. HIM professionals are directly involved with the Medicare Audit Improvement Act. The HIM professional collects health data that is subject to the audits; HIM professionals are the point of contact for responding to Medicare audit requests.

A. Discuss how you would carry out your various responsibilities as a coding manager by doing the following:

Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can leads to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.

Read the article Diagnosis Coding and Medical Necessity: Rules and Reimbursement by Janis Cogley located on the AHIMA Body of Knowledge (BOK) at http://www.ahima.org.

PROCEDURE: The patient was placed in the supine position on the operating room table, where her right hand and forearm were prepped with Betadine and draped in a sterile fashion. We infiltrated the thenar crease area with 1% Xylocaine, and once adequate anesthesia had been achieved, we exsanguinated the hand and forearm with an Esmarch bandage. We then created a longitudinal incision just at the ulnar aspect of the thenar crease and carried the dissection down through the subcutaneous tissue. We identified the transverse carpal ligament and incised this

Responsibilities: Perform Follow-Up Appointments, Refer Patient to other doctors for more in depth tests, First point of contact for family members

Train the physician, the physician assistant, and the billers to recognize key elements: ICD 10 codes, CPT codes, and verify correct patient’s demographics: name, address, and provider’s and insurance Group #/member ID #, address, phone numbers etc.

Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly, or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can lead to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of the patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.

To rectify the issues I suggest that the doctors get educated with the ICD/CPT codes and get educated on the new LCD policies. The coders themselves need to keep updated with any changes that were made in coding and reimbursement policies. An important part of avoiding errors is communication

Best accredited Medical Billing and Coding Schools, jobs, salary and requirementsReturn to ContentMedical Billing and Coding SchoolsMedical billing and coding is one of the best careers for people who enjoy working with numbers and want to be involved in the medical field. Billing and coding can be learned through a specialized career or vocational school and does not require a four year degree. What Is Medical Billing and Coding?When a patient visits a doctor for an exam, has a procedure or has a test, the doctor's office files a claim with the patient's insurance company. The medical office works with both the patient and the insurance company to receive payment for the exam, procedure or test. In order to file the insurance claim, the medical office staff must use standardized

Proper medical coding is important, from ensuring accurate payment for physicians to creating a valid record of patient care history. In addition to aiding the medical billing process for procedures administered and helping expedite the payment of services for physicians, medical codes also serve the purpose of comparing projects for research and planning for under-served health care areas, aiding in administrative functions, as well as identifying symptoms that have medical necessity and referenced by other physicians or specialists. As an example, for a general urinalysis, the coder must input the code of 81000 for male or female patients. The mistake that could be made is if the coder input 81025 for a specific urinalysis for a pregnancy test. This event could happen if the diagnosis was reversed and a female expecting a pregnancy urinalysis gets a general urinalysis ordered. It may seem minor, but this type of error can still be