Medical Billing: A Case Study

The continue use of ICD-9 codes after the effective date could result in the denial of reimbursement claims. This task can be assigned to the healthcare organization’s management team to determine a solution avoiding a break down in the system. Rahmathulla states, “In instances of an audit, appropriate documentation will make the query process substantially easier while enabling coders to clarify issues without having to query the provider multiple times for answers” (“Migration To The ICD-10 Coding System S187). It is important to accurately document to reduce the amount of claim denials. With the new specificity requirement of the ICD-10 and documentation supporting a claim, lowers the chances of healthcare fraud. The healthcare management team will oversee the process to prevent the risk of exposure.

The Centers for Medicare and Medicaid Services (CMS) requires all providers to implement ICD-10 coding system begin on October 1st, 2015 so the U.S. healthcare system can communicate in the same language as with other countries’ systems. The transition from ICD-9 to ICD-10 had big changes from 14,000 diagnostic codes to more than 68,000 and 4,000 procedure codes to 87,000. The transition affected the reimbursements of hospitals. Medicare requires all patients’ procedures and services to be coded using ICD-10 system while they are charged in CDM using CPT codes. However, there is no direct link between ICD and CPT codes (Jensen, Ward, & Starbuck, 2016). The CDM committee had to work together to prepare for this event. Switching from numerical

When I first read this discussion, it made me curious as to why it would be important to join a professional organization for Medical Billing and Coding. After reading about a few of them, I believe it is a pretty good idea. Joining a well known, professional association shows employers that you work to high ethical standards. It is also very hard to keep up with the quickly growing billing, coding, and compliance regulations. One of the organizations I read about joining is the MAB, Medical Association of Billers. This group provides members with the most updated information on Medicare and Tricare changes, coding & reimbursement trends, medical electronic claim submission, Healthcare Insurance Regulations, Medical ccounts Receivable strategies, managed care trends, and

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a system that is used by physicians, and health providers to classify and code all diagnoses, symptoms, and procedures. This system consists of about 68,000 codes, compared to the ICD-9-CM which has only about 13,000 codes. These codes are used to be able to bill patients’ medical insurances. Since there are more codes in the ICD-10-CM there will most likely be less claims. And medical insurance providers will have a clearer understanding of what they are being billed for. Since there are more codes for diagnoses. To prepare for ICD-10-CM, I’m glad I have all my books for reference whenever I may need it. And what knowledge I receive from this class

Yes it very important to have employees who are trained in the medical billing and coding because without the proper training it can lead to many errors in billing and coding and it’s our responsibility in the medical billing and coding to have the proper coding. You are so right when it comes to Medicare because they do watch their claims very close. So it’s employees duty in making sure that all documentation and Dx and coding is up to date so that there are no errors in order to get paid.

Medical coding is a very detailed process in which health care professionals use to code an insurance claim, to submit for reimbursement of services. In the following scenario, my task would be to explain the process and steps I took, to code patients cases using ICD-9. When coding it’s very important to code correctly to avoid delays in reimbursement and proper reimbursement. The following will explain the steps I took to perform proper medical coding.

Resolve concerns, conflicts, and problems while ensuring that assistance is provided in a professional manner.

One example is recognizing conditions that may affect a certain region of the body, such as a patient being diagnosed with rhinosinusitis and was prescribed a two-week regimen of antibiotics. From the medical report, the biller/coder must be able to apply proficient knowledge of medical terminology. The coder should be able to break down the medical term rhino-sinus-itis. The anatomy for rhino is nose, the physiology of the nose is the lined membranes which is sinus and the condition is (-itis, the inflammation of). Understanding the basic body function enables the biller/coder to translate the provider’s medical documentation for correctly coding and billing. The diagnosis code was always the same for each billing would be for the initial evaluation of a new patient outpatient or billing and coding for an established patient

The outlook and future for billing and coding professionals seems to look brighter as information technology continues to advance in healthcare in a positive way. Employment opportunities are expected to grow at a much faster rate than other average occupations. With the transition from ICD-9 codes to the new ICD-10 system, the demand for skilled medical billers and coders is particularly high right now which translates to more jobs with higher salaries. There are a few factors that continue to contribute to the demand for medical billing and coding professionals one being that more Americans are insured and the average population age is increasing as baby boomers approach retirement and the increased demand for healthcare services. The importance

Medical codes are used for various recording and reporting purposes within the medical industry. These codes can determine the diagnoses and treatments used in patient care, as well as the mortality and morbidity data that provide statistics. As time and technology progresses a strain has been amplified on coding systems used today that warrants a major update. The United States (US) has yet to implement the most current standardized set of medical codes that have been adopted by the rest of the developed world. This delay in part caused by Congress and the American Medical Association (AMA) is causing the American population to suffer in various ways. As implementation dates are being pushed back time and time again the field is increasing debt by lost opportunities and still not able to communicate medical data across US borders. The International Classification of Diseases , tenth revision (ICD10) can, with the help of the Affordable Care Act (ACA), reduce costs for medical treatment for patients and facilities as well as improve upon facility efficiencies and quality of care. Healthcare providers in the United States (US) should be mandated to implement current sets of International Classification of Diseases (ICD) without further delay to reclaim the forefront of medical care against the top-rated systems of other countries around the world.

Technology can be advantageous for medical billing services that strive for effectiveness and efficiency. With the help of readily available medical billing software, healthcare organizations have the opportunity to swiftly determine whether there is a chance for the claims to be accepted or denied because of billing rules for insurance plans, Medicare and Medicaid tend to change very quickly. The best soft wares are updated automatically as rules and policies change. This way, it becomes easier for medical billing professionals to work towards increasing the revenue they can collect for clients.

Coding systems are standardized systems used in over 100 different countries to decrypt all services, conditions and items to be billed to a patient or their insurance provider. There are two main coding classifications systems: International Classification of Diseases (ICD) and Current Procedural Terminology (CPT). Currently, ICD is in its 10th edition making the current complete system name ICD-10. ICD-10 uses up to seven

The Centers for Medicare and Medicaid (CMS), American Medical Association (AMA), private insurance providers, and a multitude of other healthcare governing agencies have set forth thousands of policies and guidelines that hospitals, nurses, physicians, and even patients must adhere to in order to participate in the healthcare system The politics of healthcare is not limited to within the United States alone. The diagnostic terminology currently in use by America known as the ICD-9. This classification system was created by the World Health organization in 1978, and is considered outdated by many healthcare providers in the US as well other countries around the world. According to the World Health Organization (2015), there are 117 countries that have updated their nosology to ICD-10 and are using this to report mortality data as a primary indicator of health status. The use of ICD-10 by so many other countries has no doubt put pressure on the United States to update out healthcare recording system. It has taken more than a decade, but our country will be changing to ICD-10 on October 1st of this

Thanks for considering Reliance Medical Management for your medical billing and management needs. I really appreciate your courtesy and time in considering our services and I know that my company can help your office with its desired needs, even if we both must go back to the drawing board or assist you in finding another route to take. I understand it's hard to know who to turn to and trust.

Having a reliable and speedy electronic billing system like MedBook can help reduce the complexity of medical billing and the headaches associated with rejected claims. Moreover, the billing system can also be used to help detect fraudulent practices. MedBook is a cloud solution that provides patients (suffering from diseases) health care professionals (like doctor, nurse, hospital staff), and health care payers (insurance providers) a platform for exchange of information about billing activities, benefit inquiries, and EHR. With MedBook physicians can access information about the status of their medical claims, and submit information that becomes part of the patient’s EHR. Patients can be notified about the approval of medical procedures,