One professional organization is the “Professional Association of Healthcare Coding Specialists” (PAHCS). This organization is a communication network and member support system that enhances compliance, documentations, and reimbursements of healthcare coders. PAHCS confidently code for the maximum and honest reniburstments. Another organization is the “Healthcare Billing & management Association” (HBMA). This association is one of the most valuable resources; from answering general questions regarding coding, to more specific relating to billing fields. The members who work for this association uses their expertise to assist with invaluable experiences and can help others keep in touch with professionals as well. They keep connections who know
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).
Medical billers often communicate with physicians and other health care professionals to explain diagnoses or to attain further information by means of phones, email, fax, etc. The biller must know how to read a medical record and be familiar with CPT®, HCPCS Level II and ICD-9-CM codes.
The term radiology can indicate any number of methods used by a physician to do diagnostic testing. Therefore, reading the entire description will prove extremely useful to find the appropriate codes. For example, if a patient had an angiography, read the entire procedure to know if it is pertaining to the patient’s abdomen, arm, or chest. If it is the chest, do not use the first code you see. Read the entire description of the code. The first code under angiography, chest is “71275,” which describes the procedure as “computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing”. The other code under angiography, chest is “71555,” which describes the procedures as, “Magnetic resonance angiography, chest (excluding myocardium), with or without contrast materials(s)” (“Current procedural Terminology;” American Medical Association; Fourth Edition).
Patient Credentialing identifies people who have a certain diagnosis and have achieved certain levels of competency in understanding and managing their disease (Watson, Bluml, & Skoufalos, 2015). Patient Credentialing (PC) was developed to meet 3 core purposes: (1) enhance patient engagement by increasing personal accountability for health outcomes, (2) create a mass customization strategy for providers to deliver high-quality, patient centered collaborative care, and (3) provide payers with a foundation for properly aligning health benefit incentive (Watson et al., 2015). The goal is for patients to achieve a proficiency in managing their chronic conditions to promote chronic conditions competencies and self-management.
Around 595,800 establishments make up the healthcare industry. The healthcare industry varies significantly in staffing partners, size, and organizational structures. Even though hospitals make up only 1 percent of healthcare organizations they provide work for 35 percent of all workers in the industry. 76 percent of the healthcare organizations are formed by offices of dentists, physicians, and other health practitioners. The healthcare industry is designed to administer care 24 hours, respond to needs of patients, diagnose, and treat. The purpose of this industry is to combine the human touch with medical technology (U.S. Bureau of Labor Statistics, 2010).
The Healthy Body Wellness Center 's (HBWC) Office of Grants Giveaway (OGG) provides medical grants to hospitals and facilities. The company 's mission is to promote improvements in the quality and usefulness of medical grants through federally supported research, evaluation, and sharing of information. As part of fulfilling the businesses objectives of the HBWC OGG has contracted with We Automate Anything (WAA) to design and implement the Small Hospital Tracking System (SHGTS). The SHGTS is vital in the current functioning of the OGG as part of the HBWCs mission statement, and allows for the monitoring and distribution of grant funds. The SHGTS also functions to coll...
The modern nurse has much to be thankful for because of some of the early pioneers of nursing, such as Florence Nightingale and Jensey Snow. However, the scope and influence of professional nursing, as well as the individual nurse, has seen more exponential growth and change in North America since the establishment of the first professional organization for nursing, the Nurses Associated Alumnae of the United States and Canada, which in 1911 came to be known as the American Nurses Association.
“An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users.” (healthit.gov) The EHR mandate was created “to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.” ("Providers & Professionals | HealthIT.gov", n.d., p. 1) The process has proved to be quite challenging for providers. As an incentive, the government began issuing payments to those providers who “meaningfully use certified electronic health record (EHR) technology.” (hhs.gov) There are three stages that providers must progress through in order to receive theses financial incentives. Stage one is the initial stage and is met with the creation and implementation of the HER in the business. Stage two “increases health information exchange between providers.” ("United States Department of Health and Human Services | HHS.gov", n.d., p. 1) Stage three will be the continuation and expansion of the “meaningful use objectives.” ("United States Department of Health and Human Services | HHS.gov", n.d., p. 1) The hospital, where I work, initiated the HER mandate many years ago. In this paper, I will discuss the progression and the challenges that my hospital encountered while implementing the EHR mandate.
With consolidation among hospital systems over the last few years there has been a trend toward ways to streamline processes. By having “shared services” such as laundry services, human resources and radiology and diagnostic services it’s possible to lower costs and have common processes. The advent of health care reform and the Affordable Care Act (ACA) with its Information Technology (IT) incentives has led to greater interest in risk management and IT solutions. While there was a decrease in 2012 on outsourcing IT services the finalization by the Supreme Court of the ACA and President Obama’s re-election cemented the need for an IT solution (Kutscher, 2012)
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
The national pay for value based system development has positive and negative aspects. System implementation will require multiple entity participation. Hospitals, physicians, outpatient centers, and clinics all will be responsible for collaboration in developing an integrated communication system which will present additional expense on the front end. Government mandates will be required; from implementation dates to specified circumstances in which assistive funding may be available. Multi provider ...
Case 1 -- You work in a busy multi-specialty clinic with a high patient volume. The physicians enter the type of code that will yield the greatest reimbursement. You suspect the codes are not accurate.
When I was younger I use to pretend to be a doctor or nurse. It was always fun to go around and check to see who had a heart beat, who was bleeding, and who was hurt. I knew that I wanted a career in the medical field, but was unsure if I really wanted to be a doctor or a nurse. I thought the only career was to be a doctor or nurse. Of course, the medical profession is larger than that. It includes office staff, EMT’s, nurses, physician assistants, and several other kinds of physicians. While the opportunities are endless in this career field, I have decided that being a doctor or nurse was not what I really wanted to do. It takes too long; the schooling alone is longer than four years. I was not willing to spend more than four years in school. Instead I decided that I wanted to do something that is in the same field as a doctor or nurse. Yet, something that takes less time in school to get a degree for. In addition, I wanted it to be something that I could do to help doctors, nurses, and patients. That is when I found out that Medical Coding and Billing is what I wanted to do.
reimbursement determinations. As a result, the camaraderie among physicians has developed into a more aggressive approach to impede competition (Shi & Singh, 2012). Little information is shared with patients in regards to procedures or disease control. The subjects are forced to rely on the internet for enlightenment on the scope of their illnesses (Shi & Singh, 2012). Furthermore, the U.S. health care system fails to provide adequate knowledge on billing strategies for operations and other medical practices. The cost in a free system is based on supply and demand and is known in advance of hospital admission (Shi & Singh, 2012). The need for new technology is another characteristic that is of interest when considering the health care system. Technology is often v...
Physicians, administrators, staff, and patients who are affiliated within the healthcare organization should understand the importance of interoperability by coming together to ease situations, in efforts to create a better community. Most communities have more than one healthcare organization available for service.... ... middle of paper ... ...