...Briefly explain causes and solutions for three of the most common billing and coding errors. What effects does the medical national correct coding initiative have on the billing and coding process? Pg.207- 211 Working in medical billing and coding can be very challenging and demanding. In this field there is absolutely no room for any mistakes. There are many common billing errors such as using inappropriate modifiers or no modifiers, billing an invalid or outdated code and billing non covered services. Most health care payers base their decision to pay or deny claims only on the diagnosis and procedure codes. Simple errors and mistakes such as typos, incorrect dates, and double billing. Typos, or typing mistakes, can occur when entering a patient’s name or address. Although these may seem not as vital compared to entering the correct code it’s still very important to double check all records, files, and bills before submitting them. There are ways errors in billing and coding can be solved. Patients need to review billing statements when they receive them by mail, to be certain that the statements contain no typos, incorrect dates, or double billing. Improper coding that can lead to incorrect payment for Medicare claims. These claims are controlled by the Medicare National Correct Coding Initiative (CCI). The coding policies of the CCI are derived from the coding guidelines of national medical societies. Physicians are required by CCI to report the most extensive version of...
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...Coding and Billing Paper Richard Carter Grand Canyon University: HCA 530 Professor King July 18, 2015 This paper will discuss how Community Mental Health Rehabilitative Services (CMHRS) are billed under Medicaid in comparison to other industries and the impact that private and government insurers and payers have on the reimbursement process. How Medicaid is administered and funded Medicaid is a government program that is administered through the U.S. Department of Health & Human Services (HHS) in order to assist low-income people pay for part or all of their medical bills. It was created by the 1965 Social Security Act. It is federally governed but locally administered by each State. States use private health insurance companies to administer their Medicaid programs. These providers are essentially HMOs that contract with the state Medicaid department to provide services for an agreed-upon price. Other states work directly with the service providers. How to Code and Bill Medicaid for CMHRS Services In Virginia Magellan Health is the Behavioral Health Services Administrator or BHSA that the Virginia Department of Medical Assistance Services (DMAS) contracted to manage and direct Virginia’s Medicaid programs. All community mental health and rehabilitative services providers under contract with the Virginia’s Department of Medical Assistance Services must contact Magellan Health directly for information on the reimbursement and claims processing instructions...
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...MEDICAL BILLING AND CODING CAREER Medical Billing and Coding Wanda F. Pervish Instructor: Elbert Trone Learning Framework 12 December 2012 MEDICAL BILLING AND CODING CAREER Abstract 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. MEDICAL BILLING AND CODING CAREER Medical billing and coding professionals hold pivotal roles in hospitals, doctor’s offices, physician’s practices and specialty medical practices. They are responsible for the accurate flow of medical information and patient data between physicians, patients and third-party payers. Without them, healthcare businesses could not function efficiently. A medical billing and coding specialist’s main goal is to provide medical billing and coding services so the health provider is paid for medical services rendered. Every medical service is assigned a numeric code to define diagnostics, treatments and procedures. It is the medical biller and coder’s job to enter this information into...
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...Medical Billing and Coding Medical Billing and Coding is an occupation that is rapidly growing. If you choose to work from home or in an office the salary can fluctuate. If working in an office then there are benefits such as 401K and health insurance. If working from home, these options are not available with most companies. A medical biller and coder works with the patient and many insurance companies to file claims. “The biller will submit and follow up on any claims in order to receive payment for services rendered by the health care provider. This usually involves learning many codes, each one representing a symptom, medications and diagnoses, in order to process the claim properly” (“Medical Billing Career”). Because there are so many different codes that you need to learn education is necessary for success....
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...History and Future Of Medical Coding and Billing John F. McMahon BU480, Central Methodist University Abstract Medical coding and billing affects everyone during their lifetime and yet the regulations of medical coding and billing are extremely complex. Examining the history, evaluation, and effect of new regulations and their cost shed light on an already complex industry. We will review government regulations, technological advancements, and requirements that providers will face in the near future. We will examine our current systems and how they evolved through time and what they may be in the future. We have reviewed articles from the Medical Billing and Coding Association, the Department of Human and Health Services as well as the Office of the Inspector General. We will review the different types of insurance, how they each affect the process of medical coding and billing and then see what the future will be. Finally we will review what steps we have taken that has allowed a government to be so involved in our healthcare decisions. Thesis Statement Medical Coding and Billing has evolved to a point that it affects everyone at one time or another during their lifetime and has only led to complex rules and regulations that you almost need a degree to understand. From times that Physicians bartered for their services to the government telling them what to charge and insurance companies...
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...MARKETING PLAN FOR ABIGAIL’S MEDICAL BILLING AND CODING Abigail’s Medical Billing and Coding Services, LLC is an accurate, timely and affordabl Here are the major elements of a marketing plan: Executive Summary: The Executive Summary should be a brief summary of the entire marketing plan and include the highlights of each section to be included in your marketing plan. It should also include your Business's Mission (or Vision) Statement. Start with your Mission Statement and use this as a foundation for the rest of marketing plan. Next, work on the rest of the plan, skipping the remainder of this section until the rest of the marketing plan is complete. Your Mission Statement should be a simple paragraph describing your company's values as well as what your company does and who it is. After the rest of the marketing plan is complete, come back and finish the Executive Summary. Product Description: The product description is the detailed description of the products and/or services that you intend to market. Anywhere in length from a few paragraphs to a few pages, use this as an opportunity to communicate your ideas regarding exactly what your product is and how your customers will use it. Market Analysis: The Market Analysis is drawn from in-house or third party Marketing Research and includes: * A description of the target market * Distribution channels with any applicable laws or regulations * The unique positioning of the company and its products...
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...Hello, Rashonda! It's so nice to finally meet someone who isn't in the same program as me. I also have seven children: a 19-yr old boy, a 17-yr old boy, a 15-yr old girl, a 10-yr old boy, a 5-yr old boy, a 3-yr old girl, and a 1-yr old boy. They all live at home with us except for our 15-yr old, who lives with her mom, and since my husband works so much, "Busy" is my middle name. Believe it or not, I actually tried my hand at Medical Billing and Coding, once upon a time, and absolutely loved it. The only flaw was that once school was over and I was certified, no one in my small town was hiring for entry-level billing and coding. Be that as it may, though, I still gained quite a bit since HCPC, ICD9, and ICD10 codes are often used in pharmacy,...
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...Correct Medical Billing and Coding in the Healthcare Industry Medical billing and coding is one of today's topics. When services are billed for patients, they must be coded based on the documentation the physician has dictated in the patients chart to receive payment from the insurance company. As the physicians office and/or hospitals practice correct medical billing and coding, this will prevent audits being brought forth in their practice and/or hospital. Kenny, Christopher,Correct Coding for Dialysis Billing Providers must ensure proper coding to avoid returned claim, 2012. This article is geared for those in the medical field who do coding and billing in hospitals for dialysis. The author is educating the coders and billers how to correctly code for dialysis billing. He mentions that The Centers for Medicare and Medicaid, issued a transmittal that has revised the Medicare claims processing manual as it pertains to hospitals billing for dialysis procedures that are non covered under the ESRD benefit for emergency dialysis. In addition, the author discusses how the hospitals should utilize Healthcare Common Procedure Coding System billing code G0275 and code 90935 for hemodialysis. Only to bill G0275, if the hospital is a ESRD facility, emergency services, and when dialysis is performed with related procedures, such as a vascular access procedures or when performed following treatment for an unrelated medical emergency. The author also continues to...
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...Jennifer Sanchez MOD 160 Night Class M.B&C Chapter 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing 1. Define compliance. 2. Name the two provisions of the Health Insurance Portability and Accountability Act (HIPAA) that relate most to health care. 3. Explain the difference between Titles I insurance Reform and Title II Administrative Simplification. 4. Describe the Privacy Rule under HIPAA. 5. Define protected health information (PHI). 6. Identify the difference between disclosure and use of PHI. 7. Illustrate the difference between privileged and nonprivileged information. 8. Explain patient rights under HIPAA. 9. Explain responsibilities of the health care organization to protect patient rights under HIPAA. 10. State the guidelines for HIPAA privacy compliance. 11. List the three major categories of security safeguards under HIPAA. 12. Define the provisions of the HITECH Act. 13. List the civil and criminal penalties of noncompliance with HIPAA regulations. 14. Identify the difference between fraud and abuse. 15. Identify the Federal and State laws that regulate health care fraud and abuse. 16. List the various fraud and abuse audit programs 17. Describer the basic components of an effective compliance program. Compliance Defined * All regulations, recommendations, and expectations of regulating agencies must be met to be in compliance. * The professional elements...
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...Running Head: MEDICAL BILLING AND CODING Medical Billing and Coding as a Career Abstract: Since I became a mother, I have always wanted a job that would allow me to work at home. I have an associate in accounting and tried doing bookkeeping from home but that did not really work out. I did some research and found that being an insurance medical biller and coder is one of the best jobs to have for working at home. Top Medical Billers can earn over $40,000 a year either at home or in the office. “Employment of billing and posting clerks and machine operators is expected to grow by about 4 percent from 2006 to 2016. In 2006, billing and posting clerks and machine operators held about 542,000 jobs; 566,000 jobs are projected by 2016.” (medicalcareersguide, 2007) In choosing a new career path I did a lot of research on my options. The path to success always starts with the right attitude, education, training, networking, and experience. We want to inspire you by not only speaking about the medical billing and coding career but also by giving examples of real people who succeeded. Learn all there is to know about entering into this rewarding field, finding medical billing jobs, and succeeding in your chosen career. This website also answers many questions about starting your own medical billing business, either in a small office space, or from home. I decided upon medical billing and coding because it is a rapidly growing healthcare field and it sounds exciting....
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...#1…Public health IN THE United States, primary care remains a medical model. This is in contrast to much of the world, where the 1978 Declaration of Alma-At a which recognized that attaining health for all also requires interaction from social and economic sectors - is considered standard. Today, there is much buzz about patient-centered medical homes, a concept that promises to transform the practice of American medicine. There is much to praise about this most recent iteration of the medical home. But the missing ingrethent in all these definitions and models remains public health. A population focus that addresses the social determinants of health is an essential component of primary health care. In the United States, such a comprehensive approach has been labeled community-oriented primary care. This model is built firmly on the Alma-Ata principles and incorporates a public health approach to health services. Community-oriented primary care organizes the delivery of health services, around a population, not simply a collection of individuals. It identifies a population - most frequently a geographically defined community - and uses epidemiology and interventions to improve community and individual health and well-being. In this model, both individual patients and the community are the foci of the delivery of health services. Primary health care stands at the intersection of personal and population health services. It requires integrating medical models of primary care...
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...Errors in Compliance and Coding April 19, 2013 Errors in Compliance and Coding There's several causes that create billing and coding error in the medical field. One of the biggest errors that are made are typos, billing the same thing and dates that aren't listed on the patient's file. Typos is the most common error that is often done. When you have typos, that creates problems for the patient, doctor and the billing department. One major mistake is in the address and patient's name. Now there's double billing. Codes are used to show certain procedures have been done, but if a patient is doubled billed for the same procedure like a flu shot. The patient had one shot but was charged for two. Another common error in billing and coding is incorrect dates. Incorrect date such as patient's that are in hospital can be listed as staying for three days but was billed for eight days. This is considered to be one of two major problems that's often seen because if a patient is due for surgery on a specific day and was not done until a month later, this is considered a billing error. The only way to fix billing and coding errors are by checking and rechecking the patient's statements before there sent out to the patient. If by chance there is an error on the statement, a letter of apologize can be written in response to the billing and coding error that was made. If there's no return response, contacting the protective office in the state the error was done...
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...Evaluating Compliance Strategies Patricia Estrada HCR/220 November 2012 Deborah Ryan Medical billing and compliance strategies are used to bill for medical procedures and treatments. The compliance strategies are in place to prevent incorrect billing, but mistakes are still made. Answers to the importance of correctly linking procedures and diagnoses, the implications of incorrect medical coding, and how medical coding, physicians and payer fees are related to the compliance process will be discussed. It is very important that procedures and diagnosis are correctly linked together. There are certain steps to follow that help to correctly link the procedure to the diagnoses. By following the correct procedures to apply the correct codes that link procedure with diagnosis, insurance companies can be correctly billed for reimbursements. Correctly connected claims can be analyzed and to make sure charges are for medically necessary services provided to the patient. Correct claims help reduce the chance of an investigation of the practice of fraud and the risk of liability in an investigation does occur. (Valerius, J., Bayes, N., Newby, C., & Seggern, J. , 2008). If the procedures are not linked correctly to the diagnoses, then they will not be covered by the insurance company and therefor will not be paid. The major implication of incorrect medical coding would be fraud. Even though incorrect work may simply be an error, it may also represent a deliberate attempt...
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...help to reduce errors by making sure that the staff is properly trained and that the office has updated coding and billing software. I think that each office should have a guide that consists of codes which would aid the employees in the billing process. Some offices currently use sheets that are in the front the patients file that contain diagnosis and the codes, which is filled out by the physician. This helps reduce errors in the billing process when the physician completes the code themselves. The Medicare National Correct Coding Initiative is responsible for controlling improper coding and invalid payments for Medicare claims. It is extremely important to correctly link the procedures and diagnoses so that the claim will not be rejected. When claims are rejected due to incorrect linking of the procedures and diagnoses this could result in a loss of money by the physician or the medical facility. When this error occurs claims have to adjusted and then resubmitted, which results in outstanding patient balances due to errors in the medical office. The main implication that occurs form incorrect medical coding is that the medical facilities financial status could be jeopardized. In order to ensure that the medical office is receiving the proper payments for the services rendered, the medical office needs to make certain that the medical facilities coding and billing patterns are overseen closely by auditing the medical records and monitoring these processes in house...
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...Errors in Compliance Coding Double billing, typos, and incorrect dates are among the most common causes of billing and coding errors that can happen. Double billing is when you have a procedure done by your provider and they try to charge you for two procedures. It could also be something as simple as a hospital billing you for taking two pills when you were only given one. Typo’s are another common billing and coding error, and can be found in the patients name or address. The last is incorrect dates entered into the file. It could be that you stayed in the hospital for four days but the hospital has you listed as staying for seven days and they end up charging you for those seven days. Solutions for the coding and billing errors are to make sure you double check your statements when they come in to make all the information is correct. If a mistake is found, you need to write a detailed letter and send it to the facility or to a patient representative to make sure the error is corrected. The Medicare National Correct Coding Initiative (CCI) controls improper coding that would lead to inappropriate payment for Medicare claims. CCI has coding policies in place that are based on the coding conventions in CPT, Medicare’s national and local coverage and payment policies, National medical societies coding guidelines, and Medicare’s analysis of standard medical and surgical practice. CCI has thousands of CPT code combinations that are by computers to check claims in the Medicare...
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