Nt1330 Unit 3

The majority of the time the use of HIM coders are involved in billing and reimbursements. However, coding specialists are important players within the healthcare industry.(Davis, 2014,2007,2002) They certify that providers maintain accuracy with coding procedures and government rules. (Davis, 2014,2007,2002) HIM functions and complex of regulatory requirements where coding can be very challenging. (AHIMA, 2016) The coders follow guidelines of the American Health Information Management Association AHIMA) Code of Ethics. (AHIMA, 2016) On the patient level, it is vitally important for the coder to code accurately because this information will trail the patient success throughout their course of treatment and beyond.

Healthcare is one of the biggest and most important fields throughout the world. Within healthcare, there are several careers such as medical billing and coding which contribute for a better healthcare. Medical billing and coding plays an important behind-the-scenes that role in the health care system. The majority of medical billing and coding “specialists rely on their knowledge of anatomy, medical terminology, health conditions, and medications to assign diagnostic and procedural codes for each patient encounter” (Ewing, 1999).

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.

The compliance process is set up to ensure the maximum appropriate reimbursement for health care claims. Correct billing and coding are directly linked to correct documentation by a physician. Also, to complete documentation, linking the correct code to the correct diagnoses is a must. This step is vitally important in reducing compliance errors. Second, the implications of incorrect coding can have a domino effect and will ultimately cause many people in the chain of events to go back, review, correct the errors, and resubmit the claim. This could also cause the patient and payer more money or cause a claim to be denied.

With the implementation of the ICD-10 coding system, many problems and challenges have arisen. Teaching the physicians and other medical staff how to correctly code with the new system has been first and foremost a problem. Also, if medical coders don’t have the correct codes marked, they can just revert to the “non-specific” code, and this will eventually throw off their collected data and could possibly hamper their efforts for full reimbursement.

A medical coder “is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician's notes, laboratory and radio logic results, etc. Medical coding professionals help ensure the codes are applied correctly during the medical billing process, which includes abstracting the information

Evaluation and management coding is a medical coding process in support of medical billing. The health care providers must use the evaluation management coding system in order to be reimbursed by Medicare, Medicaid, and private insurance. The medical record documentation is critical to providing patients with quality care and is required for the providers to receive accurate and timely payments for furnished services. The six different steps of the evaluation management section are: Step 1: Identify the Category and Subcategory of Service. Step 2: Review the Reporting Instructions for the Selected Category and Subcategory. Step 3: Review the Level of E&M Service Descriptor Examples. Step 4: Determine the Extent of History Obtained Step 5: Determine

Coding is quietly independent work but communicating with other coders, medical billers, physicians and auxiliary office employees are crucial medical coders are usually placed on fairly tight production schedules and are normally to complete a certain number of notes each day or to keep their lag days at a particular timeframe. Lag days is the number of days it takes for the note to be documented to the real claims submission date. The main date is typically between two to five days at generally. And here main in VEE technologies there have business development teams they directly approaches USA customers.

Medical coding is similar to conversion. It is the process of changing medical diagnoses and procedures into numbers, letters, or both. A diagnosis is the process of determining by examination the nature and circumstances of a diseased condition. For every injury, diagnosis, or medical procedure, there is a matching code. There are a number of sets and subsets of code we must be familiar with. The first is the International Classification of Diseases, or the ICD9-CM, which correspond to a patient’s injury or sickness. Next, the Current Procedure Terminology, or CPT codes, is related to the type of services the provider completed on the patient. . Providers use two types of claim forms to bill insurance for a patient’s services and procedures.

A study done by Jackie Mocygemba and Susan Fenton (2012) the clinical documentation in inpatient care to see if it uses enough detail for ICD-10. Since ICD-10 is a coding system that uses much more detail than others, it is expected to improve the ability to analyze clinical and cost data (Mocygemba et al., 2012). With the increased specificity of the coding system, the purpose of the study was to see if the clinical documentation is detailed enough. The pilot study was cross-sectional and it used a variety of about 500 records that were coded using ICD-10. Once the coding was finished by two coders recruited by proficiency assessments, the accuracy of the coding was assessed on a randomly selected sample of 10 percent of the cases. The

This week we have learned many things about patient accounts and data flow in our chapter. Such as patient accounts, data flow, and charge capture have to work together to ensure the hospital benefits. A patient’s information is collected at registration, and is used throughout the patients stay at the facility. As well as the patients care services and capturing charges. The billing process is also very important to hospitals as well as workers, because without it the hospital and employers would not make any money. The billing process helps maintain financial stability. The hospital must have an efficient process for making reimbursements for patients and third party payers.

Medical coding is the assignment of numeric or alphanumeric digits and characters to specific diagnostic and procedural phrases (Understanding ICD-10-CM and ICD-10-PCS). The ICD-10-CM or International Classification of Diseases, Tenth Revision, Clinical Modification coding system allows healthcare providers and facilities to answer the question "What brought the patient to my office/facility?" This information is needed for statistical purposes, reimbursement, and continuity of patient care (Understanding ICD-10-CM). The coding system known as CPT or Current Procedural Terminology are five-digit codes that are part of the language used by physicians and insurance companies to convey what services was provided to a patient (Understanding Procedural

During a patient visit, all that is done for the patient must be transcribed into the correct codes. Along with these codes, there must be sufficient supporting information documented in the patient record. When the supporting evidence is not there, that line will either be down-coded or the billing being rejected. A rejected bill requires more time and effort by the physician’s staff to correct the issue and resubmit it. Billing with the correct primary, sub and supporting codes will prevent the extra work and possible loss of money. This is not just an ethical and financial need to do so, but a legal responsibility. In many cases, the coder is held responsible for incorrect or erroneous billing.

Including internal procedures for coding, how to query a physician and what should be included during the query, and audits within each department. Second, by educating employees and medical staff of the facility, it allows each of them to become familiar with the current laws and regulations. It is important to discuss each role with preventing abuse and fraud, and what steps are taken if the employees do encounter unethical behavior. Coders must stay informed with the changes, and should be automatically included in training, when a new hire and annually as well. Depending on the department, the employee may need extensive training on certain matters. For example, employees involved in the coding department may need to become update with the changes with ICD-10 adding codes and employees involved in release of information should be up to date on HIPPA laws. Third, routine review of coding and billing reports are used to determine the status of billing and coding steps. Holding a routine review of these reports can be helpful with the changes in coding and billing. Fourth, documentation strategies are necessary in the clinical documentation improvement program. It should be noted in the policies and procedures that copying and pasting is a function that should not be used due to the increase risk of making a mistake and possibly making a mistake in the electronic health record. Also, it can deliver a mishap with physicians copying and pasting information into the wrong patient chart. For example, the wrong test results could be pasted in the patient chart from the previous

Another major issue that affects the quality of care is the implementation of new coding systems under the International Classification of Diseases by the United States government. In order to further understand the affects of these coding systems, we first should look at how they actually work. The current coding system being used nationwide, ICD-9, works as a way of identifying certain medical procedures and making sure that these medical procedures match the diagnosis. For instance, Dr. Karen Malley, a podiatrist, sees an average of twenty patients a day. Due to the limitations of her license, she can only do procedures that relate to that of the foot, therefore, she has a relatively small number of diagnosis codes that she has to learn