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Medical Billing Errors

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Medical coding is not difficult for the right person. It requires attention to detail because nothing can be missed when processing patient information and everything needs to be assigned the proper code. The most challenging point comes for students that are just starting out. It requires the knowledge of anatomy, physiology, pathophysiology, and medical terminology to successfully learn the coding systems. It is critical for professionals working in the field to stay on top of these changes to avoid documenting inaccurate information. As a medical billing specialist, it’s critically important that minimize any coding and processing errors as you file claims. Healthcare providers receive the majority of their revenue through the processing
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As it is, practices are struggling to meet the October 1 ICD-10 compliance deadline. Assigning ICD-10 codes before then will cost real money. For example, if you want to design a billing system, it would have to include both ICD-9 and ICD-10 codes simultaneously. This could prove expensive depending on the healthcare vendor contracts.

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936 Words | 4 Pages

1. Have began the process of updating the forms for Psychiatric Evaluations as well as the forms to document follow-ups visits (Medication Management). The purpose is to improve the flow of information, simplify its use, assure the appropriate content, and facilitate arriving to the appropriate billing codes. 2. Met with all extended providers, as well as doctors to continue to ensure consistency in the delivery of quality care and the utilization of best practices, Participation in the MACRA/MIPS on a weekly basis 3.

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283 Words | 2 Pages

E/M codes tell what was done in the office. Everything that the doctor or physician has done is documented, and coded. If a certain thing was not done then it should not be coded, and charged for that is considered fraud. Also everything that is done in the office must be documented, and coded using the E/M codes. If the E/M coding was done incorrectly the person would get in trouble for fraud, and not only that the office would have a bad reputation, and other insurance companies wouldn 't probably want to go through that office anymore.

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Certified Coding Specialist are experienced professional coders who use ICD-10-CM and CPT coding systems to categorize information from patients medical records for insurance reimbursement purposes (AHIMA). Retrieve medical records of patients for review of clinical data. Assign codes accordingly per ICD-10 and CPT coding guidelines. Communicate and cooperate with healthcare facility and billing offices.

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There are two Associations for Medical Coders, one is the American Health Information Management Association (AHIMA) and the other is the American Academy of Professional Coders (AAPC). AHIMA is the leading association of health information management for professionals all over the world (www.ahima.org 2015). In 1928, AHIMA was known for refining the quality of health records. “AHIMA is working to advance the implementation of electronic health records by leading key industry initiatives and advocating high and consistent standards” (www.ahima.org 2015). AHIMA 's credentials includes Certified Coding Associate (CCA)

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523 Words | 3 Pages

A core element of confidence building is showing the professionals how to value and use information adopted for coded data. This type of information has the power to describe medical necessity in support of admissions, readmission’s and continued stays. An example I would like to give is, by pinpointing

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589 Words | 3 Pages

ICD-10 was developed without physician input. This one does actually sound like a myth. If you were to design a coding system for the healthcare industry, whose primary objective is to classify and report diseases in a healthcare setting, doing this without physician input would be tiring as it would be

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131 Words | 1 Pages

2015 Step-by-step Medical Coding Carol J. Buck Elsevier RE: Discussion # 7 8/5/2015 9:49:45 PM I agree with your post, Corina. It's very important to make sure coding is done right. Nobody wants to have to go through lawsuits for fraud.

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It is important to enter correct codes for patient billing because the insurance needs to know what the patient is being diagnosed with so they can charge the right amount. When incorrect codes are entered by someone, the claim that was submitted can be rejected or denied. A rejected claims means that there is an error within the claim which means that the claim has to be corrected and resubmitted. A denied claim means the claim has been determined by an insurance company to be unpayable. Both types of claims are often denied or rejected because of common billing errors or missing information, but can also be denied based on patient coverage (Medical Billing

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219 Words | 1 Pages

In 1893 the International Statistical Institute approved a standardized system for classifying deaths. In 1949 The World Health Organization realized the ide of enacting a system for tracking mortality as well as causes of diseases on a global basis. The Manual of the International Classification of Diseases, injuries and causes of death {ICD} has served as the foundation for the modern practice of medical coding. There are three major types of coding systems Current Procedural Terminology {CPT}, Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases (ICD). On October 1,2015 ICD-10 was put in to affect before this ICD-9 was used.

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Catherine, I did not realize how important the modifiers were to the Medicare billing process. Since reading some of the discussions this week I understand the role of modifiers much better. It is essential that we are able to choose the correct modifier because it can avoid fraud and abuse. After doing a little research I found that one of the top billing errors is from choosing the incorrect modifier. Because every code does not require a modifier I 'm afraid I will have trouble determining which code needs a modifier and which ones do not.

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I think it’s wrong for the government to penalize physicians for not meeting compliance standards. However, It’s a great opportunity for the government to aim at small practices because this is where physicians are self-employed. These types of physicians have numerous clinic or health care facilities and are most likely to commit fraud. This seems kind of biased, but it’s true. According to, Ornstein, the most common sanctions are against physicians who have odd Medicare billing reputations (2014, title).

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1123 Words | 5 Pages

Medical coding is the right career choice for me. The responsibilities and work expected match well with my personal strengths. The field is growing rapidly. It’s the perfect time to get an Associate’s Degree in Medical Reimbursement and Coding. However, before committing to starting a new career path, there are many questions I need answered about this field.

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691 Words | 3 Pages

They keep accurate records of patients' symptoms, medical histories, medical procedures, treatments, exam results, lab or X-ray test results, diagnoses, and treatment plans. Some medical billers specialize in coding patients' medical procedures to ensure that insurance companies bill and process them correctly. ”1 According to Chapter 10, all students, health providers, and financial personnel must understand the billing and coding process in health care (Buchbinder & Shanks, p. 248). For students, the entry-level management position will, at the very least, require an understanding and grasp of the basic concepts of billing and coding.2 Health providers are the doctors, physicians, and nurses providing care for the patients and are categorized into For-profit and Not-for-profit health care organizations.2 Financial personnel are responsible for providing the accounting

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430 Words | 2 Pages

Health care providers are in business. To get payment for services rendered to patients, these providers must submit claims to the patients ' insurance. In most provider offices, there are medical billing and coding specialists who submit claims to insurance and work with patients to set up payment. Understanding the role of the medical billing and coding specialists will help with understanding how medical billing works in medicine today. Are medical billing and coding the same thing?

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