Current Procedural Terminology

Introduction The current state of United States’ health care system is one of the most polarizing subjects of debate among scholars and other health care professionals across the globe. This can be attributed to the fact that at one extreme end, there are some who argue that that Americans have the best system of health care in the world (MePhee, 2013). Perhaps the availability of the state-of-the-art facilities and free medical technology that have become highly symbolic of the various industries

Extended Opthalmoscopy 1. What is extended ophthalmoscopy and what are the different types? a. Extended ophthalmoscopy is basically a detailed drawing/examination of the fundus that is more specific in terms of a general comprehensive eye exam. It is indicated for a wide variety of posterior segment pathology. There are two types of EO which are billed, initial and subsequent extended ophthalmoscopy. i. Initial: done during the initial evaluation of the disease ii. Subsequent: done during later

Health insurance fraud is what drives up health insurance premium costs, wastes taxpayer’s money, but can also endanger beneficiaries or leave them uninsurable. In 2015, Medicare Strike Force reported over $700 million in false billing by doctors, nurses, other licenses medical professionals, laboratories, and individuals (FBI.gov). This is a staggering figure that is only getting worse. In this fictitious federal case I will be describing the criminal offender, the crime that was committed, the

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. There are many common

From the first hospital founded in 1751, by Dr. Thomas Bond and Benjamin Franklin and the first mental health facility started by the Quakers in 1752, there have been many changes in both settings. (UPENN & NIH) Two of those changes include documentation standards and reimbursement. Hospitals have gone from being known as a place most went to die to a place where people can be cured and put back together. When many think of the hospital the first thing to come to their mind is a place someone

Kristin Barry September 13, 2013 HCA 245 Moiz Lalani Interview with a Medical Coder Medicine is an art, it is science and business. There are scientific and artistic aspects those doctors learn in the profession of medicine. Doctors have to be paid which requires a different skill that is complex and comes with administrative professional. Hint a Medical Biller and Coding. Medical Billers and Coders work with clinics, doctors, hospitals, patients, and other medical facilities. Submitting

APRN fall within the APRN’s scope of practice under their state law. Commercial third-party payers do not consistently provide reimbursement for the APRN; however, their rates and policies differ (Buppert, 2005). The APRN submits either current procedural terminology (CPT) codes or evaluation and management (E&M) codes for Medicare reimbursement. CPT codes are a systematic listing and coding of procedures or services performed by the APRN. The American Medical Association (AMA) establishes, maintains

One of the biggest misconceptions is that Medicare is self-funded with premiums of current beneficiaries and the payroll of the future beneficiaries .The taxpayers pay for Medicare under the Social Security Amendment, so out of the 2.9 percent, 1.49 percent is paid by the employee and the remaining is paid by the employers. Those who are self-employed pay up the entire 2.9 percent (Rivlin, 2013). METHODS OF REIMBURSEMENT USED IN HEALTHCARE SECTOR In order to understand how frauds occur in Medicare

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. There are many

services, programs and the legal system. This paper explores the business process of entering into community supervision and explores the accommodations for limited and non-English proficiency clients. In addition, it highlights the current systemic and procedural guidelines for staff and suggests ways to improve processes including the