Regulatory and contractual compliance Medical billing and medical coding fall under many state and federal guidelines. Does an online medical billing and coding certificate program offer flexibility to suit my schedule?
Failure to stay up-to-date on medical billing rules and regulations. Certified billing companies are compliant with the latest health care laws, like HIPAA and the Health Care Reform bill, so your staff can rest assured that the law is being followed.
HIPAA protects patient confidentiality, requiring any medical practice or hospital to take safeguards to protect confidential patient information. Coding is also critical for demographic assessments and studies of disease prevalence, treatment outcomes and accountability-based reimbursement systems.
Medical Coding Image Source: This helps to reduce overhead costs for salaries and wages and provides a seamless interface for all practice operations, from scheduling, reporting, coding and billing.
Medical billing is the act or process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. Many large medical groups have this same type of adjustment with private insurance companies.
In the opening example of the surgeon who performed a procedure on a patient with multiple underlying medical problems, the surgeon was planning a colorectal surgery on a patient with heart disease and hypertension. These medical billing codes are for the diagnosis of mental illnesses.
What is Medical Coding? However, when everything is added up, it may end up being more beneficial over time. The only pre-requisite for enrollment in these programs are a high school diploma or equivalent. Contracts spell out negotiated rates for various medical procedures and treatments.
International Classification of Diseases ICD These codes have been around sincebut the version used in the United States is updated annually based on input and suggestions from payers, physicians, and others medical contributors. Outsourcing Medical Billing Outsourcing medical billing sounds expensive upfront.
But per the American Medical Billing Association AMBAan increasing number of health care facilities and physicians want to hire billers who are certified because their knowledge of regulatory and business issues can help offset fraud and increase revenue.
The majority of these codes fall into the following categories:"Practices miss revenue when the billing staff doesn't correct and resubmit denied claims," says Nancy M. Enos, coding consultant for the Medical Group Management Association and a coding instructor for the American Association of Professional Coders (AAPC).
Medical Billing and Medical Coding are not the same. Medical Billing is the process to submit claims to those covering the cost of the service or treatment and Medical Coding is the process of applying the correct codes on health records and claims.
National Correct Coding Initiative The National Correct Coding Initiative (NCCI) was initiated by the Centers for Medicare and Medicaid Services (CMS) to promote correct practices for medical billing codes for Part B claims.
The purpose of the NCCI edits is to prevent improper payment when incorrect code combinations are reported. Medical coding is a major factor in obtaining insurance reimbursement as well as maintaining patient records. Coding claims accurately lets the insurance payer know the illness or injury of the patient and the method of treatment.
The CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services (Coding Policy Manual). The Coding Policy Manual should be utilized by carriers and FIs as a general reference tool.
Home Health PPS Coding and Billing Information includes: HH PPS HIPPS code weight table - See "Downloads" section below.
These spreadsheets map each of the HIPPS code for the HH PPS to its associated case-mix weight.Download