Questions On Correct Billing And Coding - 1220 Words

In order to be a better or more knowledgeable about correct billing and coding, the coder must first be aware of the impact of the issues that can occur in a claims process when incorrect information is documented or coded about the patient. The main possible impacts of incorrect information in a claim are: rejected claims, down-coding of the bill by the insurance company, loss of payment to the physician and additional audits. During a patient visit, all that is done for the patient must be transcribed into the correct codes. Along with these codes, there must be sufficient supporting information documented in the patient record. When the supporting evidence is not there, that line will either be down-coded or the billing being rejected. A rejected bill requires more time and effort by the physician’s staff to correct the issue and resubmit it. Billing with the correct primary, sub and supporting codes will prevent the extra work and possible loss of money. This is not just an ethical and financial need to do so, but a legal responsibility. In many cases, the coder is held responsible for incorrect or erroneous billing. Correct and Clean Coding Other than the ethical issues of coding, the best methodology to follow is to code by these three coding guidelines. a) First, code the primary diagnosis, condition or reason for the visit followed by the co-existing, current circumstances. b) Next, with the supporting evidence, code to the highest level you are mostShow MoreRelatedMedical Billing And Coding Specialist1039 Words   |  5 PagesSuppose you are a medical billing and coding specialist. Your boss comes to you, gives you a list of services that a patient has had in a day. On the list it says: blood test $125.00, X-ray $300.00. Your job is to calculate the total bill. So in this case you would have to add up the cost of services received. The total bill amount is $425.00. What exactly is a medical billing and coding specialist, and how do they automate the process using algebra, and common calculations through Excel or any otherRead MoreRole Of The Medical Insurance Specialist1322 Words   |  6 PagesICD codes and CPT billing codes, research, correct and resubmit rejected and denied claims, bill patients and answer patient questions regarding charges. The billing process is actually the process of communication between the insurance specialist, medical provider, patient and the insurance company. This is considered the billing cycle. The billing cycle could takes days to complete or it could take months. The patient demographic information is the first step in the billing cycle. The patientRead MoreIs Outsourcing Medical Billing Worth the Cost? Essay1134 Words   |  5 PagesOutsourcing medical billing in today’s economy; is it worth the cost? This is a question I am sure many physicians find themselves asking. When the real question should be: â€Å"Can you afford not to outsource your medical billing in today’s economy? â€Å" Having worked in a medical office for many years and doing medical billing in that office, I have seen first hand the lack of attention and dedication that is placed on the medical billing department. Many times in a busy medical office the jobRead MoreEssay on Evaluating Compliance Strategies1941 Words   |  8 Pagesappropriate reimbursement for health care claims. Correct billing and coding are directly linked to correct documentation by a physician. Also, to complete documentation, linking the correct code to the correct diagnoses is a must. This step is vitally important in reducing compliance errors. Second, the implications of incorrect coding can have a domino effect and will ultimately cause many people in the chain of events to go back, review, correct the errors, and resubmit the claim. This couldRead MoreEvaluating Compliance Strategies1136 Words   |  5 Pagesmedical billing, and compliance strategies, and the evaluation of these strategies. Many mistakes are made during the billing process, and some of the mistakes that are made could be caused by the strategies, and the processes themselves. In this essay I will offer a quick overview of the strategies, and an evaluation of these strategies. I will also offer my suggestions on how to fix the problems that were found in the evaluation. In this essay I will also attempt to answer these questions: WhatRead MoreReimbursement Methodologies1120 Words   |  5 Pagescase mix, manage on going reimbursement and quality issues, ensure that health record documentation supports services billed, assign diagnostic and procedural codes according to patient record documentation, apply coding guidelines and edits when assigning codes or auditing for coding quality and accuracy. This department may also assist in appealing insurance claims denials. 2. Describe the importance of Blue Cross and Blue shield plans in the evolution of health care coverage. Blue Cross andRead MoreHca/230 Working with Teams1113 Words   |  5 Pages The scenario is inaccurate coding and lack of patient information which delays payments for the doctor. As head of the billing department a process will be implemented to solve problems on this issue. The current process is not working and because of the loss of productivity, a team was assembled to solve problems. The goal is to find where the error is, and recoup the loss revenue. The first person to question would be the front office personal who checks inRead MoreHistory Of Evaluation And Management ( E / M ) Codes1482 Words   |  6 Pageserroneous and inappropriate imbursement for provided health care services. Evaluation and Management (E/M) coding principles and guidelines were founded by Congress in 1995 and amended two years later. E/M codes are based on the foundation of the Current Procedural Terminology (CPT) codes recognized by the American Medical Association (AMA). Active health care suppliers access E/M coding for medical reimbursement by Private Insurances, Medicaid, and Medicare programs. The E/M codes are a methodRead MoreMy Future Career Within The Healthcare Industry1659 Words   |  7 PagesHowever, besides Obama Care, individuals have HIPAA. According to Forney, â€Å"the primary purpose of HIPAA is to provide continuous insurance coverage for workers and their insured dependents when they change or lose jobs† (2014, p. 24). However, billing specialist should know that this type of HIPAA â€Å"affects individuals as consumers [and] not as patients† (Fordney, 2014, p. 24). When it comes to health insurance or any information pertaining to patients’, healthcare employees should keep the patients’Read MoreWho You Gon Na Call967 Words   |  4 PagesBased on the case, Who You Gonna Call by Kevin D. Zeiler, Nicki is working in the billing department for a large, for profit health care organization. She has been working for the company for two and a half years and was just recently promoted to senior Medicare Billing Specialist. Due to her recent promotion she has been granted the ability to information she was not able to before, she then found discrepancies surrounding the way many of the Medicare invoices were coded. She informed her supervisor