Recommended: Understanding hospital coding and billing chapter 1
Circumstance: Ms. Smalls (MHP), Mrs. Gailliard (MHS), Clarence and Ms. Elizabeth Strong (DSS Worker) schedule medical appointment with the MUSC Foster Care Clinic. Action: MHP called Tara Peevy, RN at the MUSC Foster Care Clinic after MHS explained leaving several messages. Ms. Strong explain emailing the referral form to the clinic. Machelle Green explain receieing the referral form, however unable to reach the DSS worker for additional infromaiton.
Initially, facilities voluntarily used HCPCS codes, but with the implementation of HIPAA in 1996, facilities began to report HCPCS for transaction codes (Webb, 2012). CPT (Current Procedural Terminology) is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations (Rouse, 2015). The HCPCS level II coding system has a selected standard coding system with a wide acceptance among both public and private insurers. The HCPCS level II codes set are alphanumeric code set and primarily include non-physician products, supplies, and procedures not included in CPT. For HCPCS to bill the and identify the service that are been used such as.
How ICD-10 impacts the revenue cycle management by Sashi Padarthy discusses the “opportunity” for facilities to improve on “clinical documentation, revenue cycle performance, and analytic capabilities for business intelligence” (Padarthy, July 2012, p. 7). Padarthy suggests the shift from ICD-9-CM to ICD-10 will require multi-departmental assessments to determine core factors within ICD-10 will that will directly influence coding, billing and reimbursement. Padarthy proposes facilities analyze their current diagnostic and procedural codes to assess whether their current codes accurately represent services provided. In addition, he asks facilities to determine “if an opportunity to leverage ICD-10” exists, and if so, what is needed; updated eligibility requirements, increased medical necessity
HCPCS codes facilitate the procedure of processing health insurance claims made by insurers such as Medicaid. The HCPCS is divided into two levels or classes. The task of classification lies with the Centres of Medicaid and Medicare Services (CMS) in association with the HCPCS work group and other third party payers. Classification is done quarterly, marking a significant step-up from its previous system of annual updates. Since 2014, the CMS has been implementing several changes regarding the continuation of HCSPCS level II.
• DFCS assistance: Medicaid • DFCS History- yes same related issue • Income-Logistic-transport clothes in and out of the country. • DOB: Denikca Davis-4/23/1986 A’Neeya Belton-1/28/2008 • CM Gilmore explained Hipaa and release form information-signatures were provided by Bmo. • CM Gilmore observed the home being clean, minor clutter but no safety concerns. All appliances were working (the hot water in the bathroom at the sink had to be turned on under the sink).
For example, hospitals can ensure that all written policies for assisting low-income patients are applied consistently. In addition, hospitals can review their current charge structures and ensure that they are reasonably related to both the cost of the service and to meeting all of the community’s health care needs. Finally, hospitals could also implement written policies about when and under whose authority patient debt is advanced for collection. The Financial Impact of MACRA
The endorsement of two new Current Procedural Terminology (CPT) codes recognizes echocardiographic myocardial strain imaging and myocardial contrast perfusion echocardiography as emerging technologies, often an essential beforehand period while a code is promoted to payable status. CPT codes define medical, surgical and diagnostic services and procedures. These codes interconnect uniform data about medical services and procedures to healthcare providers, payers, administrators and accrediting bodies. Vital as fiscal and logical tools. Innovative codes are essential when new skills enter clinical practice, as was the case for myocardial strain imaging and myocardial contrast perfusion echocardiography.
Group I, Category 66 Insufficient Documentation to show conformance to procedural requirements when a disability determination is based on failure to cooperate. ISSUE The DDS proposes a denial of this claim based on failure to cooperate. However, proper closeout procedures were not followed, as the claimant’s whereabouts possibly are unknown. CASE DISCUSSION & POLICY ANALYSIS (INCLUDING SPECIFIC REFERENCES)
HCPCS Level II codes commonly are referred to as national codes or by the acronym HCPCS, which stands for the Healthcare Common Procedure Coding System. HCPCS codes are used for billing Medicare and Medicaid patients and have been adopted by some third-party payers. These codes, updated and published annually by the Centers for Medicare and Medicaid Services (CMS), are intended to supplement the CPT coding system by including codes for nonphysician services, administration of injectable drugs, durable medical equipment (DME), and office supplies. The main terms are in boldface type in the index.
This rule adopts standards for eight electronic transactions and for code sets to be used in those transactions. It also contains requirements concerning the use of these standards by health plans, health care clearinghouses, and certain health care providers. The use of these standard transactions and code sets will improve the Medicare and Medicaid programs and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the system and enabling the efficient electronic transmission of certain health information. It implements some of the requirements of the Administrative Simplification subtitle of the Health Insurance.
With ICD-9 in place now in the health care industry there is a huge volume of fraud being committed in the coding and billing department. Patients are being over charged for procedures that cost half the price, or charged for procedures that were never performed on them. This is costing health insurance companies
With medical billing being so important for most medical practices and facilities, accuracy is critical. Insurance companies quickly deny claims that include inconsistent, inaccurate data, and that can cost a medical practice in additional man hours and lost revenue. Making sure accuracy is a key component throughout the billing process keeps claim denial to a minimum. Let 's break it down a bit Pre-registration When the patient walks through the doors, that is when billing process begins.
Medicare has recently begun to scrutinize Emergency Medical Ambulance Transports just as routinely as non emergent ambulance transportation. They have begun denying emergent transports when it is deemed that the patient did not warrant the service, or could have been transported by other means. It is imperative that municipal providers of emergent ambulance services, not only code for the proper levels of service, but also use the correct ICD10 codes, in order to avoid Medicare post payment reviews, and other avoidable pitfalls. DM Medical Billings is Level II HIPAA complaint. We currently have a certified Medicare Compliance Officer on staff, and three additional certified ambulance coders.
Based on this case the cost driver is to properly distribute the direct cost among the different divisions. Dr. Julian would like to control her departments costs by having them distributed fairly among the divisions without affecting the hospital’s reimbursement/revenue. Carroll University Hospital is currently using the standard costing unit, which is based on the cost of bed/day for inpatients. Currently the present cost accounting system that is being used at CUH takes the total direct cost of the departments, then allocates the indirect costs and distributes it among the departments evenly regardless of the actual resources being used in those departments, and without considering that there may be some patients in these divisions that may require more resources than others, this method does not seem to recognize the different activities,
The RP reminded the facility the resident is receiving a Medicare Assistant Waiver and could not afford the one on one care. The RP stated the facility was aware of the resident 's medical condition by her personal physician and the resident 's medical issue had not changed since admission. The RP stated the facility was provided with detail information regarding the resident’s needs and
