Coding In Healthcare

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.

Coders have to be mindful of how inaccurate coding on their behalf can affect others. Constant training in an organization is a great way to keep coders updated with coding practices and will allow open communication in how to deter errors within the department. Besides affecting patient health and insurance companies returning claims coders should take into consideration that inaccurate coding creates more work for multiple departments within their organization. If more man-hours are needed to correct mistakes facilities lose revenue to spend on resources to improve patient care.

As viewed by many HIM professionals Computer-assisted coding is a valuable tool for enhancing the effectiveness of coding and billing. CAC software scans medical documentation in the electronic health record (EHRs) using a natural language processing (NLP) engine, identifying key terminology and proposing codes for that specific treatment or service. Human coder then revised these codes. CAC can also investigate the background of key words to conclude whether they need coding.

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

In this case, CAC technology also provides a connection between EHR documentation and transcription systems. Primarily, CAC technology in a healthcare environment has rapidly and drastically changed the process in which medical coding in health-information management. This is handled for a better productivity and efficient workflow solution, including production monitoring, coding review, management reporting, computerization of coding and auditing. Clinical documentation is ensuring that it has routinely generated medical codes from computer assisted codes (CAC). In addition, CAC technology has enabled healthcare organizations to recognize the revenue-cycle process as they increase their requirements towards improved quality. The complete implementation of the CAC technology is essential when improving the main necessities towards patients, such as the efficiency, quality, productivity, and management of their care. Last but not least, CAC technology has produced one of the best strategies for the challenges that the HIM professionals face as coding becomes one of the most important aspects of transitioning to

Due to the growing inpatient/outpatient requirements, as well as the impending update to the ICD-10 codes; the spearfish regional hospital is in dire need of a new Computer assisted coding system (CACS) with ICD-10 code language. This technologies will assist the coding department with their day to day processes, as well as allow the hospital to continue with its growth to meet the higher demands of our growing community. Included in this report will be a detailed report of the technologies being requested, as well as information on these vendors 3M, Nuance, and Optum who can supply these

An accurate and specific documentation of universally accepted set of codes are important for the protection of healthcare providers as well as increased reimbursement for services received. These codes are for the validation of which services the patient received from their health care provider ( (Page, 2009). Having the correct codes in place insures the provider with the information needed by the health insurance carrier. Maintained by the AMA (American Medical Association), this universal numeric assignment is also used for developing guidelines for medical care review as well as data collection for medical education and research (Scott, 2013).

According to Rosenbaum et al. (2015), healthcare documentation combined with clinical communication that is coded for hospitalized patients is an important part of medical care. The paper or electronic healthcare record is then submitted to third party payers that provide reimbursement for services based on the guidelines of the Centers for Medicare and Medicaid Services (CMS), Medicare Severity Diagnosis Related Group (MS-DRG), and inpatient prospective payment system (IPPS) (Rosenbaum et al., 2015). The

The definition for Medical Billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a health provider. The definition for Medical coding, is the process of converting diagnosis codes to ICD-9/10 codes and procedure codes into CPT codes. A Medical Biller and Coder may specialize in different areas. One area is in-patient facilities, and another area is in and out-patient facilities. An In-patient Coder works in an in-patient facility such as a nursing home, a rehabilitation centers or a hospital. Coders who work in hospital facility may utilize a different skill set, than those who work in a different kind of a health facility. A Coder needs to be

In order for a patient’s insurance claim to go through correctly, you (as a medical assistant) need to code correctly. In the medical field coding is used to identify diagnoses patient’s have and services provided for them. The codes are then submitted to the patient’s insurance company, so the patient does not have to pay full price for services.

Studies have found that coded data collected with a sole focus on reimbursement can poorly affect the use of the data for other purposes. Coded data goes farther and does more than ever before, making it imperative that professionals stay up to date of many rapid changes. One of the biggest changes is the expansion of coding from its traditional role of translating narrative clinical text into diagnosis and procedure codes. Coded data are now used for purposes such as severity adjustment, quality of care assessment, patient safety evaluation, public health surveillance, and decision support process development. Coding must meet an emerging need to capture healthcare data in a standard format that has universal meaning and can be applied both at the individual and aggregate levels. With this expansion come additional new responsibilities, such as entry of health information into a database and the need to understand how the quality and accuracy of the data are

Quality is something that many medical care institutions have advocated for. With the innovation of Electronic Health Records, healthcare facilities as well as institutions were consumed with the concerns of how medical records were being handled. Currently there are many national organizations as well as some of the government agencies who are trying to pursue the cause of quality and patient safety (GAO, 2010). Although, Electronic Health Records are presumed to bring quality to the way healthcare data is being handled,

What is Medical coding? (Herzing University, 2009) says, “Medical Coding is the act of billing patients and health insurances for the medical check up they received”. In other words, medical coding is the process of a medical coder recording a patient’s diagnosis. The medical coder has certain responsibilities when it comes to managing codes. Those responsibilities include: attaching health care codes, comprehending the codes, and meeting the guideline of the codes.

Computer-assisted coding is defined as the “use of computer software that automatically generates a set of medical codes for review, validation, and use based upon clinical documentation provided by healthcare practitioners”

Demographic shifts in the global population, greater levels of technological disruption due to the Internet, social media and the en masse adoption of smartphones and tablet PCs are together re-defining the healthcare informatics market. System and informatics theories have emerged as the foundational elements of healthcare informatics supported by the Data, Information. Knowledge (DIK) Model which acts as a taxonomy for these developments (Haugh, 2005). Systems and informatics theories along with the DIK Model form the ontological foundations of healthcare informatics field of research occurring today and will continue to provide a basis for further research (Braganza, 2004). The intent of this analysis is to evaluate the contributions of systems and informatics, the role of the DIK Model, expert systems in nurse care and medicine, and the use of decision aids and decision support systems. All of these elements are critically important to strategic information systems plans healthcare providers put into place to serve patients while giving healthcare professionals the applications, systems and software they need to excel in their roles (Djellal, Gallouj, 2007).