Medical Necessity Letter Research Paper

to standardize the coding systems used to process Medicare claims. This coding system is mostly used to bill for any supplies that have been used, and any injections that have been given. HCPCS codes must be used in order to bill Medicare. HCPCS codes are

.The purpose of the HCPCs , Level 2 alphanumeric codes are used to report services, supplies and equipment, such as walkers , wheel chairs , oxygen, medicines , provided to Medicare and Medicaid patients , for which no codes exist . HCPCs codes can also be required on non-Medicare and Medicaid patients, because some third-party payer's follow Medicare and Medicaid guidelines and may require that a HCPCs Level 2 code also known as G codes , be assigned. There are also certain HCPCs level 2 codes required by all payer's , such as drug codes also known as j codes. You would find these codes used in out-patient settings , rehabilitation services, doctor's offices , and you would also use them for supplies used , medications and or equipment

Identify OPPS, CPT or HCPCS Level II code descriptions for the associated codes from (Charge Master Medicare Regulatory Updates):

HCPCS level II code are 5 digits like HCPCS level I, but this ones are alphanumeric and the letter is always the first character in the code. These codes are grouped together by the services they describe and in a numeric order. HCPCS codes are designed non-physician services. Non-physician services are wheelchairs, ambulances rides, walkers, other medical equipment and services that don’t fit readily into HCPCS level I. You can generally refer to the range of codes by the initial character. One of the most important parts using HCPCS is coding for medication and is going to be very helpful the drug table because is going to give accurate information on where to find the correct code. When you receives a medical report, you have to take notes

HCPCs is a collection of codes that represents the procedures, supplies, products, and services that may be provided to Medicare and Medicaid and to individuals enrolled in private health insurance programs. HCPCs are necessary for Medicare and Medicaid providers to provide healthcare claims that are managed consistently to get payment. Some of the settings you would use HCPCs codes would be in home healthcare, laboratory services, and dentist.

Level 2 hcpcs codes are designed to represent non physician services like ambulance rides wheelchairs walkers other durable medical equipment and other medical services that don't fit readily into level one. Level 2 coders are like level 1 five characters long but Level 2 codes are alphanumeric with a letter occupying the first character of the code HCPCS code manuals have an index and a large table of drugs whenever a coder is coding the delivery of a drug or medication they should always use the drug table IN HCPCS LEVEL 2 modifiers are composed of two alpha or alphanumeric characters that range from AA TO VP level 2 codes consist of one alphabetical character letters A through V and four numbers.

Coding violations are one of the common ways that health care providers can defraud the Government. Health care provider must enter a numerical “Procedure Code” CPT (Current Procedural Terminology) code or HCPCS (Health Care Common Procedure Coding System) code that matches the specific type of care provided to the patient in order to bill either a government health care program such as Medicare, or Medicaid or private insurance company such as Blue Cross Blue Shield or a for payment.

Healthcare professionals, along with medical billers and coders use HCPCS. HCPCS Codes are needed for health insurance providers to produce appropriate claims. HCPCS codes are made up of five characters and is alpha

Coding violations is one of common ways that health care providers can defraud the Government. Health care provider must enter a numerical “Procedure Code” CPT (Current Procedural Terminology) code or HCPCS (Health Care Common Procedure Coding System) code that matches the specific type of care provided to the patient in order to bill either a government health care program such as Medicare, or Medicaid or private insurance company such as Blue Cross Blue Shield or a for payment.

The CPT coding system was developed in 1983. It is a collection of codes that represent procedures, supplies, products, and services that are provided to Medicare and Medicaid beneficiaries and to individuals enrolled in private health care insurance programs. The CPT codes helps healthcare providers communicate both effectively and efficiently with third party payers about the procedures and services provided to patients. The CPT codes are level I codes and are defined as professional services. Level II codes are National Codes (HCPCS) are alphanumeric codes that are used by providers to report services, supplies and equipment provided to Medicare and Medicaid patients for which no CPT codes exist.

We use CPT codes to describe the medical procedures, diagnostic services, products, and supplies provided to patients . We use these CPT codes on insurance claim forms. The difference between Level I and Level II CPT codes. Level I are CPT codes and Level II are National codes. Level I is the primary coding system used in outpatient settings to code professional services provided to patients. Level II are five-position alphanumeric codes representing non physician and physician services and supplies that are not represented in Level I. Both codes are maintained, copyright, approved, and developed by different organizations.

By 03/18/2016 Ms. Esru Wong verbalized to me that her pain is increasing however, is been control by medication.

A Certificate of Medical Necessity (CMN) form is a form that is required to help document other medical coverage such as medical equipment, prosthetics, orthotics and supplies. A Certificate of Medical Necessity requires the cost of the equipment, it should also include the type of durable medical equipment (DME), diagnosis or reason for DME, the length of time the equipment will be needed, start date or prescribing date and the provider name or signature. Sections A and C of the CMN form are completed by the supplier while sections B and D are completed the physician. The Centers for Medicare and Medicaid services (CMS) form number can be found at bottom of the page, CMN forms are referred to by their CMS number. A CMN form also has a DME

Clinical practice guidelines (CPG) are designed to improve the quality of healthcare services, decrease unwanted, ineffective and harmful interventions for patients. CPG are used to facilitate treatments for each individual patient’s by maximizing the benefits, minimizing the risk of harm and obtain treatment with an acceptable cost. Researchers had proven that CPG is a bridge for change and improving health outcomes. The effectiveness of CPG is perceived to be helpful in clinical decision making. CPG are developed to assist healthcare providers such as doctors and nurses in decision making for specific clinical outcomes (Vlayen, et. al. 2005)

The demand for medical care is derived from our demand for good health. Michael Grossman was the first to do econometric research on this topic. “Grossman’s work established two approaches for consideration. In the first, medical care is viewed as an input in the production function for health, and in the second, as an output produced by medical care providers (Henderson, p.142).” There are two main factors that determine the demand for medical care. The first is the patient factor. This includes a patient’s health status, demographic characteristics and economic status. The second is the physician factor. This is an interesting topic because it introduces the principal (patient)-agent (physician) problem. We are