Healthcare Reimbursement
Phase One Individual Project
Ernestine.Robles1
Colorado Technical University Online
HIT201-1104B-02
Professor Sherry Miller
November 21, 2011 (Microsoft Office Media, 1998)
Healthcare Reimbursement
Medical coding is an important process, in which descriptive information (patient medical records) is reviewed, and assigned detailed numeric, or alphanumeric diagnosis, and procedure codes’, for the purpose of reimbursing hospitals’, or physicians’ offices’, for services’ rendered (Ehow.com, 1999-2001; AHIMA.org, 2011). These codes are then translated into payment amounts, to be submitted to insurance companies’, for compensation (Ehow.com, 1999-2001). The hospitals’ and physicians’ rely on “complete coding accuracy”, or codes without “any” errors, or inadequacies (clean claims), to be submitted to insurance companies in a suitable time, in order to be processed, and reimbursed for services’ performed (Campus.ctuonline.edu, 2001-2011). The more detailed information the coder provides, the more accurate the billing and coding will be (Campus.ctuonline.edu, 2001-2011). Accurate coding is beneficial to the financial business end of hospitals’, and physicians’ offices’ because, if the coding is not correct, insurance companies will not pay the costs for the claims’ (Ehow.com, 1999-2001; AHIMA.org, 2011). Therefore, this can result in thousands of dollars’ in loss revenue for medical organizations’. To date, there are no “National” standards to really determine medical coding productivity (Ehow.com, 1999-2001). Coding productivity is determined by each individual medical organization, establishing their own “principles of productivity”, based on record categories, such as “inpatient or outpatient status (Ehow.com, 1999-2001). According to the HCPro survey (1999-2001), twenty-nine per cent of facilities used a “three records coded per hour” system, as a “benchmark” (standard), for coding inpatient records’ (Ehow.com, 1999-2001). Furthermore, the American
Ernestine.Robles1
Colorado Technical University Online
HIT201-1104B-02
Professor Sherry Miller
November 21, 2011 (Microsoft Office Media, 1998)
Healthcare Reimbursement
Medical coding is an important process, in which descriptive information (patient medical records) is reviewed, and assigned detailed numeric, or alphanumeric diagnosis, and procedure codes’, for the purpose of reimbursing hospitals’, or physicians’ offices’, for services’ rendered (Ehow.com, 1999-2001; AHIMA.org, 2011). These codes are then translated into payment amounts, to be submitted to insurance companies’, for compensation (Ehow.com, 1999-2001). The hospitals’ and physicians’ rely on “complete coding accuracy”, or codes without “any” errors, or inadequacies (clean claims), to be submitted to insurance companies in a suitable time, in order to be processed, and reimbursed for services’ performed (Campus.ctuonline.edu, 2001-2011). The more detailed information the coder provides, the more accurate the billing and coding will be (Campus.ctuonline.edu, 2001-2011). Accurate coding is beneficial to the financial business end of hospitals’, and physicians’ offices’ because, if the coding is not correct, insurance companies will not pay the costs for the claims’ (Ehow.com, 1999-2001; AHIMA.org, 2011). Therefore, this can result in thousands of dollars’ in loss revenue for medical organizations’. To date, there are no “National” standards to really determine medical coding productivity (Ehow.com, 1999-2001). Coding productivity is determined by each individual medical organization, establishing their own “principles of productivity”, based on record categories, such as “inpatient or outpatient status (Ehow.com, 1999-2001). According to the HCPro survey (1999-2001), twenty-nine per cent of facilities used a “three records coded per hour” system, as a “benchmark” (standard), for coding inpatient records’ (Ehow.com, 1999-2001). Furthermore, the American
References: AHIMA.org. (2011). Medical Coding. American Health Information Management Association. AHIMA. Retrieved November 17, 2011 from http://www.ahima.org/coding/ Casto, B Medetrac.com. (2010-2012). Professional practice management solutions. Mede Trac Systems LLC. Retrieved November 21, 2011 from http://www.medetrac.com/search.asp Microsoft Office Media