Medical Billing And Coding: A Case Study

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

occurred on Sunday. She states she was seen by the “eye doctor earlier today” and

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

ACO, another 3 letter health care organization consisting of integrated groups of providers, comes along promising the elusive goal of reducing health care cost, improving population health, and bolstering custom satisfaction. Sounds like a perpetual remake of a 70s movie called HMO that went through several reiterations over the past decades which gave us PPO, PSO, IDS, and the different flavors of MCOs. ACO’s hype is credited to the Affordable Care Act as it sought to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks that coordinate patient care and become eligible for bonuses when they deliver that care more efficiently. Bottom line, providers are promised to make more if they

My career that I am researching for my junior project is Medical Coding and Billing. Medical Coding and Billing are two different jobs. Medical Coding is when a patient has any medical procedure or exam such as going to the doctor for the stomach virus or even going to the hospital for a broken bone. They work with the insurance companies by putting a specific number into the computer. There’s CPT Codes which stands for Current Procedural Terminology which is “ Codes to better understand the services their doctor provided, to double check their bills or negotiate lower pricing for their healthcare services. (About Health, 2014).”

When I was younger I use to pretend to be a doctor or nurse. It was always fun to go around and check to see who had a heart beat, who was bleeding, and who was hurt. I knew that I wanted a career in the medical field, but was unsure if I really wanted to be a doctor or a nurse. I thought the only career was to be a doctor or nurse. Of course, the medical profession is larger than that. It includes office staff, EMT’s, nurses, physician assistants, and several other kinds of physicians. While the opportunities are endless in this career field, I have decided that being a doctor or nurse was not what I really wanted to do. It takes too long; the schooling alone is longer than four years. I was not

In the past few years the American health care system has changed in many ways. First there was the passage of the Affordable Care Act, which is a law that is giving Americans the opportunity to obtain health care. Under this new law, in 2011, the Department of Health and Human Services decided to create Accountable Care Organizations (ACO) to help doctors, hospitals and other providers better coordinate care (AthenaHealth.com). The first idea of an Accountable Care Organization was brought up in 2006 by Elliot Fisher, MD, and now there are over 400 in the United States (Healthcatalyst.com). An ACO’s primary job is to improve health care delivery, performance, and payment. This is done through physicians and

The health restructuring dispute has centered on compensating providers particularly more when delivering quality care to their patients than for enhancing the volume of services they provide (Ries, 2014) Accountable care organizations (ACOs) is a single proposed way of altering compensation methods to accomplish this objective by generating encouragement to enhance care coordination and clinical integration (Thygeson, Frosch, and Carman, 2014).

The accountable care organization I researched is called the Physician Organization of Michigan ACO (POM ACO). The POM ACO is a joint venture of the U-M Health System and physician groups around the state, with the aim of improving care for 81,000 Michiganders enrolled in traditional Medicare and slowing the growth of health care costs, according to the announcement by the U-M Health System (Daly, 2013). The group was launched on January 1, 2013 under the Medicare Shared Savings Program. 12 physician organizations from around Michigan came together to take part in a Medicare-sponsored program that strives to improve on the quality of care for traditional Medicare recipients, while also containing cost growth. In 2014, POM ACO expanded to include all the University of Michigan faculty physicians and thousands of other providers from the University of Michigan Health System. The POM ACO is now one of the largest accountable care organizations nationwide. More than 5,700 physicians and other providers are now involved in the POM ACO. Therefore, the POM ACO is organized as a physician-hospital organization. Hence, the patient has more flexibility in where and how their care is delivered. The patient can still use any doctor or hospital that accepts Medicare at any time.

The Affordable Care Act (ACA) legislated in 2010, has changed the United States health care industry. In addition to universal healthcare, one of the principles of the ACA is the ideal of accountable care. Specifically, adopting an Accountable Care organization (ACO) for Medicare beneficiaries under the fee for service program. An ACO seeks to hold providers and health organizations accountable for not only the quality of health care they provide to a population, but also keeping the cost of care down (1). This is accomplished by offering financial incentives to the healthcare providers that cooperate in, circumventing avoidable tests and procedures. The ACO model, seeks to remove present obstacles to refining the value of care, including a payment system that rewards the volume and intensity of provided services instead of quality and cost performance and commonly held assumptions that more medical care is equivalent to higher quality care (2) .A successful ACO model, will have developed quality clinical work and continual improvement while effectively managing costs, however this is contingent upon its ability to encourage hospitals, physicians, post-acute care facilities, and other providers involved to form connections that aid in coordination of care delivery throughout different settings and groups, and evaluate data on costs and outcomes(3). This establishes the ACO will need to have organizational aptitude to institute an administrative body to manage patient care,

Credentials- The American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC) offer certification in coding.

It is imperative to research the billing company prior to hiring them. Do they have certified coders working for them? Do they have the resources to know the most up to date changes from the insurance carriers? What software do they use? Do they provide in- depth reports on a regular basis to track A/R ? Do they provide training and updates to the front staff of the office, (where the actual medical billing process begins)? These are questions that should be asked of any prospective medical billing company. A physician should feel confident in the billing company’s answers and have an excellent rapport with their staff.

AAPC was founded in 1988 to provide education and professional certification to physician-based medical coders and to elevate the standards of medical coding by providing training, certification, networking, and job opportunities. The price to become a member of AAPC for an individual is $160 Annually, for a AAPC student is $90, for a non-AAPC student is $110 and for corporate will be $950 and $95 each add on. Some qualifications to join AAPC are: education, savings, acknowledgment, advocacy, events and networking. AAPC offers a variety of certifications. Instructor Certification, Physician Practice Manager Certification, Medical Compliance Certification, and Medical Documentation Certification, etc.. are some of the certifications they have.

The AAPC stands for the American Association of Professional Coders. There are over 155,000 members worldwide. They represent embers working in medical coding, clinical documentation improvement, auditing, regulatory compliance,revenue cycle management, and practice management. To join the AAPC the annual dues are $160 for individuals, for AAPC STUDENTS THE FEE IS $90 for non AAPC students it is 110 corporate membership is $950.

The AAPC represents over 155,000 members worldwide representing members in medical coding and clinical documentation improvements, auditing, revenue cycle management and practice management. All the memberships have their own benefits to appeal to each individuals needs. The individual cost to join is $160 and it includes many befits such as:Networking, savings, resources, recognition, education and jobs. A student membership with AAPC is $90, an AAPC student is enrolled in an AAPC certification course offered directly through AAPC or an approved educational partner. A non AAPC student membership costs $110, A non-AAPC student is enrolled in a certification course offered by an educational provider who is not an approved educational partner