Healthcare Common Procedure Coding System (HCPCS)
The Healthcare Common Procedure Coding System (HCPCS) are codes that are for reporting professional services, procedures and supplies. Included in that is medical equipment , ambulance services, orthotics, supplies, medication and dental procedures. The HCPCS was developed by the Health Care Financing Administration in 1983. As of 2001 the HCFA is now Centers for Medicare and Medicaid Services (CMS). HCPCS is divided into two subsystems, Level I and Level II. Level I is CPT (Current Procedural Terminology) is used for medical procedures and services done by healthcare professionals. Level I codes are all numeric. Level II codes are used to identify products, supplies and services not included in the CPT codes, such as Ambulance, prosthetics
and orthotics. Level II codes are alphanumeric, a letter followed by four numbers.
Audits are performed to make sure that healthcare providers are providing efficient care, and to determine areas of improvement. The audits specifically target procedural and diagnosis coding selections. Generally audits will come with some fear and dread, but they are needed to offer security and peace of mind once the areas of weaknesses are found. Then there can be training to help correct the issues found in the audit. There are three type of audits performed, they are external, internal and accreditation.
External audits are done by a private organization. The auditors are looking for making sure that the practice is in compliance, that code linkage is correct and that there is completeness and adherence in the documentation, such as signing of entries by the responsible healthcare provider.
Internal audits are done within the practice, to make sure that procedures are being coded correctly. Internal audits are analyze a coders ability and knowledge in doing their job, and see if there is any further training needed. Checking on all these aspects will reduce the chance of investigation externally.
Accreditation audits are for the purpose of staying with a managed care organization. Providers are accredited once a year. Someone from the MCO will visit the office and select at least 20 records and perform an audit on each one. What the auditor is looking for is documentation by the provider about a patients visit, tests ordered, prescriptions and follow up care. If documentation is not where it's supposed to be, the provider is issued a warning, for compliance to be met in a certain time frame. If tasks are not completed in the time frame, the provider can lose their accreditation with that MCO
and orthotics. Level II codes are alphanumeric, a letter followed by four numbers.
Audits are performed to make sure that healthcare providers are providing efficient care, and to determine areas of improvement. The audits specifically target procedural and diagnosis coding selections. Generally audits will come with some fear and dread, but they are needed to offer security and peace of mind once the areas of weaknesses are found. Then there can be training to help correct the issues found in the audit. There are three type of audits performed, they are external, internal and accreditation.
External audits are done by a private organization. The auditors are looking for making sure that the practice is in compliance, that code linkage is correct and that there is completeness and adherence in the documentation, such as signing of entries by the responsible healthcare provider.
Internal audits are done within the practice, to make sure that procedures are being coded correctly. Internal audits are analyze a coders ability and knowledge in doing their job, and see if there is any further training needed. Checking on all these aspects will reduce the chance of investigation externally.
Accreditation audits are for the purpose of staying with a managed care organization. Providers are accredited once a year. Someone from the MCO will visit the office and select at least 20 records and perform an audit on each one. What the auditor is looking for is documentation by the provider about a patients visit, tests ordered, prescriptions and follow up care. If documentation is not where it's supposed to be, the provider is issued a warning, for compliance to be met in a certain time frame. If tasks are not completed in the time frame, the provider can lose their accreditation with that MCO