When it comes to HIPAA, ICD, CPT, and HCPCS on how they influence each of the ten steps of the medical billing process, HIPAA influences the billing process by maintaining HIPAA compliance, as far as confidentiality and the handling of the medical record. When it comes to ICD, CPT, and HCPCS they influence the billing process they are the reference source where the codes are contained that are used to find the diagnosis, procedure, and the supply codes. But the HIPAA, ICD, CPT, and HCPCS they are all some kind of way related to have something to do with the billing process, but the ten steps during the process are…
When it comes to outpatient services, physicians are paid using CPT/HCPCS codes. Where as inpatient/hospitals are paid using a complex formula (MS-DRG), because of housing, feeding, and nursing the patient back to health. During an inpatient stay the hospital charges for the amount of time and effort spent on nursing a patient back to health. So when it comes to an operation on an elderly person, a complicated birth or even replacing an old pacemaker, the hospital will charge based on the severity of the patient’s illness. That is why inpatient coding requires daily coding of each service on each day of hospitalization, as for outpatient coding, the first listed diagnostic code indicates the reason for the encounter.…
This is step four, reviewing coding compliance, which makes sure that all guidelines are followed while the codes are assigned. A diagnosis and procedure code are used in the patient’s account and entered in the patient ledger that updates their account information. Step five takes us to review the billing compliance; there are many types of fees for the services provided by a facility. Medical insurance specialists help by determining what a patient needs billed to them and what the insurance company should pay for. Checking out the patient comes next in the steps of bill processing. The payments for the patient visit are taken care of in this step while the patient is still in the office. The codes are completed, the balance has been figured, and now the charges are discussed with the patient. After everything is paid or billed, follow-up work is scheduled, and the patient is finished in the…
Most of the codes we see in the United States today are version 9, called ICD-9-CM codes. With few exceptions, the paperwork we receive when we leave a doctor’s office will contain both CPT codes (Current Procedural Terminology) to describe the service that was rendered for billing purposes, and ICD-9-CM codes to describe why that service was provided. Further, most death certificates filed since, 1977 will have an ICD-9 code on them.…
The Healthcare Common Procedural Coding System (HCPCS) was created in 1978 and is based off CPT codes to provide a standardized coding system for descriptive specific services and…
The submittal of claims to insurance companies requesting payment for medical services provided by a doctor to a patient is called the medical billing process. Ten steps make up the process: preregistration of patients; establishment of financial responsibility for the visit; checking patients in; checking patients out; the review of coding compliance; verifying billing compliance; the preparation and transmittal of claims; the monitoring of payer adjudication; generation of patient statements; and the follow-up of payments by the patients and the handling of collections. HCPCS, HIPAA, CPT, and ICD have an influence on every step of the process. The 9th Revision-Clinical Modification (ICD-9-CM) is a global categorization of disease and contains sets of codes. These codes give information for evenly measures and diagnoses. The ICD-9 code has three digits, and these three may be followed by a decimal point and then two more digits. The Healthcare Common procedure coding system (HCPCS) does not give diagnosis information, only information about the procedure area. The purpose of HCPCS codes is to process hospital treatments for outpatient services. Physicians also use these codes. ICD-9 procedure codes are required by HIPAA for their porting procedures of hospital inpatients. The numerical codes for CPT and the diagnoses areas signed by the coding team. They make these assignments based on information given by the provider. A charge is then created, following the billing rules that pertain to certain locations and carriers. People who work on the process of medical billing have to maintain patient information confidentiality based on HIPPA rules. Employees must also be truthful and conduct themselves with integrity. Every procedure and diagnosis has to be correctly documented and then coded accurately to avoid any delays in…
Write a 250- to 350-word response in which you assume you are a medical office manager who wants to make the coding process easier for employees to understand. To facilitate a better understanding of this process, respond to the following:…
The CPT codes have three categories, starting with Category I, then Category II, and Category III. There are key words associated with these three code categories which include “common,” “optional,” and “temporary,” these key words help to make the coding process easier for employees to understand. Common codes are referred to when using Category I codes, because this category of codes is the most widely used throughout any medical practice. Category II codes are optional codes and Category III codes are known as temporary codes.…
In the inpatient coding the ICD codes are utilized whereas in the outpatient coding the CPT codes are utilized. Also contrary to as stated above…
Healthcare Common Procedure Coding System (HCPCS) is divided into two distinct subgroups: Level I and Level II HCPCs. Level I is made up of the Current Procedural Terminology Category (CPT)codes. CPT codes are used to bill public or private insurances programs for medical services and procedures.…
UP.01.01.01 requires the organization to conduct a pre-procedure verification process prior to the start of any procedure. The hospital meets this standard by following its policy titled “Site Identification and Verification (Universal Protocol)” which describes the process that is used prior to the start of any operative or invasive procedure. The hospital’s use of the “Pre-Procedure Hand-Off” checklist provides the documentation required to demonstrate compliance with the standard. Because of the criticality of this standard, I recommend a focused medical record review to measure compliance with the use of the pre-procedure checklist. If the audit reveals the checklist is completed consistently, full compliance with the standard will be verified and no further action will be required.…
Community hospital with a small number of HIM staff including two (2) Inpatient (IP)…
In chapter 5 we have reviewed major elements of ambulatory (outpatient) care and discussed changes supported by the Patient Protection and Affordable Care Act (ACA) and American Reinvestment and Recovery Act. Ambulatory care encompasses a diverse and growing sector of the healthcare delivery system. Ambulatory surgery is a continuously expanding component of ambulatory care, as new technology allows an increasing number of procedures to be performed safely and efficiently outside of the hospital. In addition to new diagnostic and treatment tools available in outpatient setting, financial mandates also have driven services into the ambulatory arena. This new development pushed more hospitals to shift procedures and services amenable to outpatient delivery from more expensive inpatient environment to less expensive. For profit, free standing facilities providing primary, specialty, and surgical services have been increased (Sultz & Young, 2014, p163-199).…
When looking in the CPT manual, we will notice that the guidelines are at the beginning of every section. The guidelines give us information that we need to know in order to report the correct code. When looking at the guidelines for coding in the anesthesia section, it explains how the physical status modifiers P1-P6 are used. Modifiers can be used to give more specificity to a code, by telling if the procedure was done on the left (-LT), right (-RT), or -50 for bilateral. When a patient is at the doctor for a check-up and ask about having skin tags removed, then we would use modifier -51 for multiple procedures at the same time.…
When people think about jobs in the health care field, it can be easy to assume that most jobs involve direct, hands-on patient care. What many people don’t realize is that administrative jobs are equally vital to ensuring quality health care services. Medical billing and coding is an important piece in the administrative puzzle that makes up the vast health industry. As with most administrative jobs, medical coding and billing professionals need to have excellent attention to detail, as one wrong code or inaccurate statement can have an extremely negative impact on a health care facility.…