Define the following terms:
• Hospital charge master:
The Charge Description Master (CDM) commonly known as the chargemaster, is the computerized system used by hospitals to inventory and record services and items provided in various locations in the hospital. The chargemaster is automated and linked with the billing system.
• Coding Systems:
Were developed to standardize descriptions of conditions, services, and items for the purpose of consistent reporting and tracking of conditions and procedures. The coding system consists of numeric and alphanumeric codes that represent a translation of the written description of conditions, services, or items provided as documented in the patient’s medical record. The coding systems required are outlined under HIPAA provisions as the standard code sets for claim submissions. Standard coding systems originally adopted under HIPAA for hospital services included ICD-9-CM, Volume I-III; HCPCS Level I CPT and HCPCS Level II Medicare National Codes; and National Drug Codes (NDC).
• Reimbursement:
The term used to describe the amount paid to the hospital for services rendered, by patients and third-party payers. The purpose of the billing process is to obtain the appropriate reimbursement within a reasonable period after the services are rendered.
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The account is updated when required to reflect new information or changes in current information. Financial activity is also entered in the patient’s account. The chargemaster is used to record services it is automated and linked with the billing system. Therefore, in order for the chargemaster to work efficiently, the information gathered at the patient registration must be correct, so that when the chargemaster records the services accordingly. In addition the appropriate reimbursement for billing
The IPPS or the inpatient prospective payment system refers to a system of payment which includes the diagnosis-related groups’ cases as acute care hospital inpatients. This system is based on resources which are utilized when treating Medicare recipients belonging to these groups. Each diagnosis-related group (DRG) comprise of a payment weight. The IPPS serves an integral role when it comes to deciding the overall hospital costs of all the devices used to treat the patient in within a specific inpatient stay.
The chargemaster or charge description master (CDM) is a basically a financial tool or an electronic system that housed detailed description/information about services charged to patients. The chargemaster can be a manual list or a file that is located in the organization’s account receivable billing system that contains hospital’s service items, and their charges. Furthermore, the chargemaster is a very crucial aspect of the reimbursement cycle and must contain vital information necessary to produce an itemized statement and claim form. Key components of the chargemaster include chargemaster
Payment basis is known as the methods used by the one making payments for services provided by hospitals or doctors. There are three payment determination bases. First, cost-payment basis is a method for determining fees for medical services, and is basically the underlying method for payment is the provider’s cost. The exact amount is determined and agreed upon by both the provider and the patient. For example, the healthcare provider’s cost for providing the service could be $2,000. The healthcare provider can then choose to charge 70% of the total charge, which comes out to be $1500. There are different levels that can be used in cost based reimbursement. On the macro basis, payment can be provided for a whole array of services. Contrarily, payments for specific items are on a micro basis. Critical access hospitals usually use macro level cost reimbursement. On the other hand, healthcare providers often use micro level cost reimbursement when charging for expensive medications, meaning that the price of those medications will be based differently than their usual services (Abbey, 2012).
To determine if the hospital can perform this many operations, one should compute the equipment (operating room) and labor (surgeon) requirements per day and compare it to the current equipment and labor capacity per day.
The American Health Information Management Association provides guidelines of elements to be included in a health care organization’s policies of a coding compliance plan. (“Coding Compliance: Practical Strategies for Success,” ahima.org, 1998).
This is a critical review of the article entitled “Selecting a Standardized Terminology for the Electronic Health Record that Reveals the Impact of Nursing on Patient Care”. In this article, Lundberg, C.B. et al. review the different standardized terminology in electronic health records (EHR) used by nurses to share medical information to the rest of the care team. It aims at showing that due to the importance of nursing in patient care, there is a great need for a means to represent information in a way that all the members of the multidisciplinary medical team can accurately understand. This standardization varies from organization to organization as the terminologies change with respect to their specialized needs.
The federal government has taken a stance to standardized care by creating incentive programs that are mandated under the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009. This act encourages healthcare providers and healthcare institutions to adopt Meaningful use in order to receive incentives from Medicare and Medicaid. Meaningful use is the adoption of a certified health record system that acquires or obtains specified objectives about a patient. The objectives or measures are considered gold standard practices with the EHR system. Examples of the measures include data entry of vital signs, demographics, allergies, entering medical orders, providing patients with electronic copies of their records, and many more pertinent information regarding the patient (Friedman et al, 2013, p.1560).
The biller normally gathers all data concerning the bill including claims transmission, payment posting, charge entry, insurance follow-up and patient follow-up.
FFS is an arrangement under which a health care provide renders treatment or tests to a patient in return for payment. This system encourages physicians and other providers to provide unnecessary services by rewarding volume and intensity of service; the outcome of the FFS system is to increase profits for providers. Because of this volume based arrangement, the FFS model is widely seen as an
What do a Medical billing clerk do? As a medical billing clerk; you must be accurate and reliable in handling accounts and documents. Must be organized, great at math and be able to deal with the heat of great amount of financial information. Correspondingly, you get to work either in a hospital or clinic as an office employee. A medical billing clerk are responsible for coding and entering medical records, and communicate with insurance companies and billing patients. Medical billing clerk is also known as has an outgrowth between 2014-2024 as an 13%. Working as a medical billing clerk you could earn up to $35, 050 a year. The type of education that are needed to be able to come a medical billing clerk are either a 2
Clinical Documentation Improvement ensures that their health care system provides the accurate recording of medical records. The health information management industry (HIM) thrives over the improvements towards clinical documentation as medical assistance validates healthcare and optimizes their medical processing system. Clinical documentation specialist (CDS) is essential in order to alter the medical landscape in a positive measure as they provide detailed documentation and medical coding. Documentation requirements for Health Information Management (HIM) professionals intend on making the healthcare data obtainable from the additional diagnoses, which will require an enhancement of the documentation system. Thus, the ICD-10 is a new tool
I suspect that the codes that the physicians are submitting for payment are not accurate. Entering inaccurate codes that will yield the highest revenue for the clinic is called “upcoding”.
The chargemaster is an integral element of the revenue cycle. It is used in generating charges for services that are rendered to patients in real time, the absence of functioning chargemaster can result in potential collapse of the revenue cycle. Hence, the process to optimize revenue cycle must include optimizing the chargemaster and all services that is associated with it. The negative consequences of nonfunctioning chargemaster can include excessive payment/overcharging, inaccurate billing to patients; and can result in stiff penalties and fines (Bielby et al,
This paper’s brief intent is to identify the policies and procedures currently being developed at Midwest Hospital. It identifies how the company’s Management Committee was formed and how they problem solved and delegated responsibilities. This paper recognizes the hospital’s greatest attributes and their weakest link. Midwest Hospital hired Dr. Herb Davis to help facilitate the development and implementation of resolutions for each issue.
Healthcare administration provides leadership and managemnt to health care systems, hospitals, and private or public health systems. There are requirements for most professions in the health industry but with the proper education and certification, most entry-level careers are attainable. Healthcare administrators are leaders so one must be able to handle the responsibility of the job. There are characteristics that can be associated with being a health care administrator. I have learned over the course of the past few weeks that this the career path that I would like to follow and have set a few goals to help promote my career growth. My research has helped me learn many aspects of this profession and what it takes