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Author: Charlotte L. Kohler
Publisher:
ISBN: 9781556451584
Category :
Languages : en
Pages : 0
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Book Description
Hospital Billing from A to Z Charlotte L. Kohler, RN, CPA, CVA, CRCE-I, CPC, ACS, CHBC With Kohler HealthCare Consulting, Inc., associates Catherine Clark, CPC, CRCE-I Darrin Cornwell, CRCS-I Janet Ellis, RN, BSN, MS Dawn Doll Homer, CPC, CRCS-I, CDC Daria Malan, RN, LNHA, MBA, RAC-CT(R) John Ninos, MS, MT(ASCP), CCS Robin Stover, RN, BSBA, CPC, CPC-H, CMAS Deanna Turner, MBA, CPOC, CPC, CPC-I, CSSGB Susan Walberg, JD, MPA, CHC Hospital billing departments are known by various names, but their staff all experience the same problems understanding and complying with Medicare's many billing requirements. Hospital Billing From A to Z is a comprehensive, user-friendly guide to hospital billing requirements, with particular emphasis on Medicare. This valuable resource will help hospital billers understand how compliance, external audits, and cost-cutting initiatives affect the billing process. Beginning with Advance Beneficiary Notice and ending with Zone Program Integrity Contractors, this book addresses 88 topics in alphabetical order, including the following: 2-Midnight Rule and Inpatient Admission Criteria Correct Coding Initiative CPT(R), HCPCS, Condition Codes, Occurrence Codes, Occurrence Span Codes, Revenue Codes, and Value Codes Critical Access Hospitals Deductibles, Copayments, and Coinsurance Denials, Appeals, and Reconsideration Requirements Dialysis and DME Billing in Hospitals Hospital-Issued Notice of Noncoverage Laboratory Billing and Fee Schedule Local and National Coverage Determinations Medically Unlikely Edits and Outpatient Code Editor Medicare Advantage Plans Medicare Beneficiary Numbers and National Provider Identifier Medicare Part A and Part B No-Pay Claims Observation Services Outlier Payments Present on Admission Rejected and Returned Claims UB-04 Form Definitions Who should read this book? Finance and reimbursement staff Chargemaster staff Billers and coders HIM staff Clinical department staff Revenue managers Compliance officers and auditors Registration staff Fiscal intermediary staff Healthcare attorneys, consultants, and CPAs Legal department staff
Author: Charlotte L. Kohler
Publisher:
ISBN: 9781556451584
Category :
Languages : en
Pages : 0
Get Book Here
Book Description
Hospital Billing from A to Z Charlotte L. Kohler, RN, CPA, CVA, CRCE-I, CPC, ACS, CHBC With Kohler HealthCare Consulting, Inc., associates Catherine Clark, CPC, CRCE-I Darrin Cornwell, CRCS-I Janet Ellis, RN, BSN, MS Dawn Doll Homer, CPC, CRCS-I, CDC Daria Malan, RN, LNHA, MBA, RAC-CT(R) John Ninos, MS, MT(ASCP), CCS Robin Stover, RN, BSBA, CPC, CPC-H, CMAS Deanna Turner, MBA, CPOC, CPC, CPC-I, CSSGB Susan Walberg, JD, MPA, CHC Hospital billing departments are known by various names, but their staff all experience the same problems understanding and complying with Medicare's many billing requirements. Hospital Billing From A to Z is a comprehensive, user-friendly guide to hospital billing requirements, with particular emphasis on Medicare. This valuable resource will help hospital billers understand how compliance, external audits, and cost-cutting initiatives affect the billing process. Beginning with Advance Beneficiary Notice and ending with Zone Program Integrity Contractors, this book addresses 88 topics in alphabetical order, including the following: 2-Midnight Rule and Inpatient Admission Criteria Correct Coding Initiative CPT(R), HCPCS, Condition Codes, Occurrence Codes, Occurrence Span Codes, Revenue Codes, and Value Codes Critical Access Hospitals Deductibles, Copayments, and Coinsurance Denials, Appeals, and Reconsideration Requirements Dialysis and DME Billing in Hospitals Hospital-Issued Notice of Noncoverage Laboratory Billing and Fee Schedule Local and National Coverage Determinations Medically Unlikely Edits and Outpatient Code Editor Medicare Advantage Plans Medicare Beneficiary Numbers and National Provider Identifier Medicare Part A and Part B No-Pay Claims Observation Services Outlier Payments Present on Admission Rejected and Returned Claims UB-04 Form Definitions Who should read this book? Finance and reimbursement staff Chargemaster staff Billers and coders HIM staff Clinical department staff Revenue managers Compliance officers and auditors Registration staff Fiscal intermediary staff Healthcare attorneys, consultants, and CPAs Legal department staff
Author: Karen Smiley
Publisher: John Wiley & Sons
ISBN: 1119625440
Category : Medical
Languages : en
Pages : 355
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Book Description
The definitive guide to starting a successful career in medical billing and coding With the healthcare sector growing at breakneck speed—it’s currently the largest employment sector in the U.S. and expanding fast—medical billing and coding specialists are more essential than ever. These critical experts, also known as medical records and health information technicians, keep systems working smoothly by ensuring patient billing and insurance data are accurately and efficiently administered. This updated edition provides everything you need to begin—and then excel in—your chosen career. From finding the right study course and the latest certification requirements to industry standard practices and insider tips for dealing with government agencies and insurance companies, Medical Billing & Coding For Dummies has you completely covered. Find out about the flexible employment options available and how to qualify Understand the latest updates to the ICD-10 Get familiar with ethical and legal issues Discover ways to stay competitive and get ahead The prognosis is good—get this book today and set yourself up with the perfect prescription for a bright, secure, and financially healthy future!
Author: Department Of Health And Human Services
Publisher: Lulu.com
ISBN: 9781716599989
Category : Medical
Languages : en
Pages : 128
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Book Description
These guidelines have been approved by the four organizations that make up the Cooperating Parties for the ICD-10-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS. These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. The instructions and conventions of the classification take precedence over guidelines. These guidelines are based on the coding and sequencing instructions in the Tabular List and Alphabetic Index of ICD-10-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-10-CM diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (Tabular List and Alphabetic Index) have been adopted under HIPAA for all healthcare settings. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. These guidelines have been developed to assist both the healthcare provider and the coder in identifying those diagnoses that are to be reported. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated.
Author: Gina M. Reese
Publisher: Hcpro, a Division of Simplify Compliance
ISBN: 9781683081906
Category : Hospitals
Languages : en
Pages : 0
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Book Description
This book serves as a comprehensive guide to provider-based clinics, from qualifying under CMS, to unique billing and coding rules, and the business decisions behind owning or acquiring these clinics. It will help readers sort through the complex regulations relevant to this unique provider type, and provide insight into recent changes, such as the introduction of Modifier -PO. CMS is looking to implement the Section 603 provisions of the Bipartisan Budget Act of 2015 regarding off-campus, provider-based departments (PBD) by January 1, 2017, according to the 2017 OPPS proposed rule. The agency is proposing to pay the nonfacility or office Medicare Physician Fee Schedule (MPFS) amount to the performing/supervising physician and preclude hospitals from billing on a UB-04 form or receiving OPPS payment for services performed at these locations for 2017, but plans to explore other options for 2018 and beyond. Physicians would be paid at the higher nonfacility rate of the MPFS, but only hospitals that have employed or contracted physicians that reassign their billing to the hospital would get paid under the MPFS for these services. Hospitals would be able to bill claims on CMS-1500 forms for physicians who have already reassigned their billing to the hospital, as in the case of employed physicians. Otherwise, hospitals would have the option of enrolling the location as the type of provider or supplier it wishes to bill to meet the requirements of that payment system (e.g., ambulatory surgery center or group practice).
Author: Jennifer Baldwin
Publisher:
ISBN:
Category : Hospitals
Languages : en
Pages : 110
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Book Description
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309133777
Category : Medical
Languages : en
Pages : 424
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Book Description
Today our emergency care system faces an epidemic of crowded emergency departments, patients boarding in hallways waiting to be admitted, and daily ambulance diversions. Hospital-Based Emergency Care addresses the difficulty of balancing the roles of hospital-based emergency and trauma care, not simply urgent and lifesaving care, but also safety net care for uninsured patients, public health surveillance, disaster preparation, and adjunct care in the face of increasing patient volume and limited resources. This new book considers the multiple aspects to the emergency care system in the United States by exploring its strengths, limitations, and future challenges. The wide range of issues covered includes: • The role and impact of the emergency department within the larger hospital and health care system. • Patient flow and information technology. • Workforce issues across multiple disciplines. • Patient safety and the quality and efficiency of emergency care services. • Basic, clinical, and health services research relevant to emergency care. • Special challenges of emergency care in rural settings. Hospital-Based Emergency Care is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.
Author: Caryn Bredenkamp
Publisher: World Bank Publications
ISBN: 1464815216
Category : Medical
Languages : en
Pages : 69
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Book Description
This book examines how nine different health systems--U.S. Medicare, Australia, Thailand, Kyrgyz Republic, Germany, Estonia, Croatia, China (Beijing) and the Russian Federation--have transitioned to using case-based payments, and especially diagnosis-related groups (DRGs), as part of their provider payment mix for hospital care. It sheds light on why particular technical design choices were made, what enabling investments were pertinent, and what broader political and institutional issues needed to be considered. The strategies used to phase in DRG payment receive special attention. These nine systems have been selected because they represent a variety of different approaches and experiences in DRG transition. They include the innovators who pioneered DRG payment systems (namely the United States and Australia), mature systems (such as Thailand, Germany, and Estonia), and countries where DRG payments were only introduced within the past decade (such as the Russian Federation and China). Each system is examined in detail as a separate case study, with a synthesis distilling the cross-cutting lessons learned. This book should be helpful to those working on health systems that are considering introducing, or are in the early stages of introducing, DRG-based payments into their provider payment mix. It will enhance the reader's understanding of how other countries (or systems) have made that transition, give a sense of the decisions that lie ahead, and offer options that can be considered. It will also be useful to those working in health systems that already include DRG payments in the payment mix but have not yet achieved the anticipated results.
Author:
Publisher:
ISBN:
Category : Administrative law
Languages : en
Pages : 684
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Book Description
Special edition of the Federal Register, containing a codification of documents of general applicability and future effect ... with ancillaries.
Author: Debra P. Ferenc
Publisher: Elsevier Health Sciences
ISBN: 0323292267
Category : Medical
Languages : en
Pages : 626
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Book Description
- Updated Claim Forms chapter covers the UB-04 claim form. - Updated information covers diagnosis and procedural coding, with guidelines and applications. - Updated claim forms and names are used throughout.
Author: Donald S. Shepard
Publisher: World Health Organization
ISBN: 9789241545280
Category : Medical
Languages : en
Pages : 106
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Book Description
A practical guide to the principles and methods of cost analysis as a managerial tool for improving the efficiency of hospitals. Addressed to managers and administrators, the manual aims to equip its readers with the knowledge and skills needed to calculate the costs of different activities or departments, analyse their significance, and use this information to manage resources wisely. Throughout, recommendations and advice are specific to the different purposes of cost analysis and the different types of decisions commonly facing managers. The manual, which is intended for use as a training tool, was finalized following extensive field testing in workshops in Bangladesh, Egypt, and Zimbabwe. Methods of cost-finding and cost analysis are thoroughly explained and illustrated with practical examples and model step-by-step procedures for performing calculations. Since hospital accounting systems in developing countries may have gaps or inaccuracies, the manual gives particular attention to reliable methods for estimating costs when existing data are problematic. The manual opens with an explanation of the many advantages of using cost-finding and cost analysis as managerial tools. These include the provision of data needed for informed decisions on operations and infrastructure investment, the planning of future budgets, the establishment of charges for patient services, and the development of mechanisms for ensuring that costs do not exceed available revenues and subsidies. Against this background, the core of the manual is presented in three chapters. The first and most extensive chapter explains how to allocate costs to cost centres and how to compute unit costs. Information and examples are presented according to seven steps. Each is discussed in terms of the types of data needed, how component cost items should be treated, and how costs can be computed in particular situations or cases. Practical examples are used to illustrate the types of questions addressed in cost analysis and the value of this information in guiding decisions. Chapter two explains how cost data can be used to improve the management of an individual hospital. Information is intended to guide decisions at both the cost centre, or department, level and the hospital level. Managerial tasks covered include budgeting, profitability, efficiency improvements, contracting outside services or producing in-house, and assessing fiscal solvency. Chapter three considers the use of cost data in managing national and regional hospital systems. Specific applications include improvements in the referral system, the appropriate use of different providers of services, and the comparison of similar hospitals to identify inefficiencies or sources of waste. The manual concludes with a series of practical exercises, followed by explanations of their answers.
