Successful Coding Applications Case Study

you were in uses a list of codes that are not accepted by the CPT manual. So now, when your records get taken to the hospital nearest

Unfortunately, Aetna’s compliance with the implant carve-out over the past five years has been anything but straightforward. By 2011, Aetna began to deny additional payment for charges billed using revenue code 278, despite its contractual obligations to pay the Hospitals for other implants billed using that revenue code. Instead, Aetna appears to be relying on an internal policy it has promulgated in an effort to unilaterally reduce its payment obligation for “Other Implants.” This internal policy, which is called the “Implants and Supplies Policy” (the “Implant Policy”), attempts to limit the implant carve-out payment to what the Implant Policy refers to as “Implantable Devices.” The term “Implantable Devices” is define by Aetna

In the daily changes of healthcare, health information technology is evolving rapidly. The generation of coding is making significant developments along the years as well. The 3M-encoder system provides number of essential options to coders in just one click. It provides sophisticated, easy-to-learn solution for accurate, complete, and compliant coding and grouping. Coders need to be acquainted with these references because they provide back up through the articles in each one of them. 3M Coding and Reimbursement System, 3M Coding Reference, and 3M Coding Reference plus have articles for coders to read and get answers to use the appropriate codes. (Prophet). Due

The main purpose was to determine if the patients would have better outcomes. The study concluded

Name examples of each patient care setting in your community. What types of services might patients receive in each setting? In my Community in TX, We have Dermatology clinic, Cardiology, Urology, Surgery Center, Dental clinic, Pediatric Health Clinic, Urgent Care, Abortion Alternatives, Rehab. The Hunt Regional Medical Center includes an extensive list of outpatient and diagnostic services from surgery to cancer care to open imaging.

Each product must go through a progression of approval, clinical trials, and post market observation protocols in order to ensure its safety and effectiveness. Stages in the development of medical technologies are scientific background and development of idea for a product, product development, approval, and distribution, diffusion, adoption and utilization of the product. Health care professional, patients, families, and policy makers all struggle to understand how health is affected by behavior, economic and social

.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

Financial Performance * Operating profits * Reduction of No Shows of Patients * Strength of Management * Reporting to allow for more grant approvals by 65%

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

These proposals often focus on using hospital DSH payments to expand coverage rather than using these sums to make payments to hospitals, using savings from reductions in other programs, or proposing new revenues (Holahan et al., 1995). The goal is to expand coverage at small new costs to the government (Holahan et al., 1995). The key features of

The careful documentation and subsequent billing process within the course of a patient’s care is an important piece within the healthcare system as a whole. Proper documentation in a patient’s chart relating to any service or procedure is not only important for this patient’s future medical care, but for the facility to receive an accurate reimbursement for the services provided. Reimbursement is affected by every department within the hospital. Healthcare is a business in the long run, and inaccuracies within the reimbursement process will affect the financial stability of the hospital. If a department is mismanaging reimbursement data it could result

The Medicare beneficiaries’ contribution to the coverage gap decreases each year, with the majority of cost absorbed by the government and the drug manufacturers. Drug manufacturers also agreed to pay a fee to the federal government health care programs on branded prescription drugs (BPD), based on its sales of BPD’s. There was an expansion of the Public Health Service Act (PHSA), that required drug manufactures to provide eligible entities with significantly reduced drug price. The PHSA, also expanded those entities such as free-standing cancer centers and critical access hospitals (CAH), that were eligible to participate in the 340B program In, addition they also agreed to increase rebates on sales of prescription drugs to the Medicaid program (Spats, 2010). The rebate was increased from 15.1 percent to 23.1 percent. In addition, drugs, such as those used for pediatric care and clotting factor drugs there was a 17.1% rebate. Perhaps, most importantly, the firms extended the rebates to Medicaid patients enrolled in Managed Care Organizations (MCO). This new agreement allows plans to negotiate rebates in addition to the new ones

RE: Purpose of HCPCS 8/3/2015 11:43:16 PM I agree with you Amanda! HCPCS codes are used for procedures, supplies, and products that are used during tests that a doctor would perform. But did you consider that they may be used to

The outmoded coding professional’s role was to describe and apportion diagnosis, procedure, and other medicinal service codes using ICD-9-CM and HCPCS/CPT coding classifications while referencing the Coding Clinic for ICD-9-CM, Coding Clinic for HCPCS,

The healthcare system has seen significant change over the past decade. This is due to improved technology, healthcare reform, and the economic crisis (Hendren, 2010). With the changes that are occurring,