An overview to the medical claims process from coding to billing #school


Medical Billing and Coding Online

Course 1: The Medical Claims Process

The United States healthcare system is trillion-dollar industry, which includes pharmacies, pharmaceutical companies, medical equipment manufacturers, and medical care facilities. The complex infrastructure that keeps this industry, which is responsible for the well-being of millions of Americans, running on a day-to-day basis relies on specialized professionals tasked with overseeing these operations. One such system is the medical claims process. The claims process can be summarized as a dual interaction between two of the largest and most important pieces of the healthcare system: healthcare providers and medical insurance companies.

Understanding the Key Players in the Medical Claims Process

The relationship between policyholders, healthcare providers, and insurance companies is essential to understand before tackling the details of the medical billing and coding process.

Healthcare providers

A healthcare provider is any facility or practice where you receive and are billed for a product or service related to your personal health. Healthcare providers include hospitals, private clinics, and pharmacies as well as specialized care providers like nursing homes, in-home caretakers, and chiropractors.

Insurance companies

Health insurance companies subsidize medical care for qualifying patients, called policyholders. Health insurance is not mandatory in the U.S. but many Americans have insurance coverage, whether they purchased it privately or obtained it from their employer or the government. Insurance policies vary, but they all operate under the same business model: policyholders pay a certain amount of money each month or year to the insurance company, which is called a premium. If policyholders need procedures for which they qualify, the insurance company pays for that procedure, either in full or in part.


A policyholder is any individual who has purchased health insurance. For example, a young adult looking for a basic insurance plan may purchase a policy where the insurance provider will pay for all medical bills that cost more than the deductible, which is a pre-arranged amount that the policyholder must pay out-of-pocket before insurance coverage kicks in.

How Medical Claims Work

The medical claims process is initiated when a policyholder goes to a healthcare provider for a medical service, which can be anything from obtaining a monthly prescription to major surgery. After the policyholder receives the service, they are usually financially responsible for a deductible, which is the amount of money that the policyholder agrees to pay before their insurance starts. The policyholder gives their insurance information to their healthcare provider, and the transaction between the policyholder and healthcare provider is complete.

Behind the scenes, the transaction between healthcare provider and insurance company begins. The healthcare provider records all the medical services and their costs offered to the policyholder. This record is known the medical claim, or bill. While working for healthcare providers, medical billers and coders are responsible for creating this record and sending the claims out to the policyholder’s insurance company, which has three options. It can:

  • Accept all expenditures and pay the bill in full
  • Deny the claim on account of a billing error (like incorrect patient information). The bill is then returned to the healthcare provider to be corrected.
  • Reject the claim outright, usually on account of the services not being covered within the health plan. The policyholder then pays for the service out of pocket.

Working with Insurance Providers

The two major types of insurance providers are managed care plans and public insurance. Learn how to handle both types of coverage below.

Managed care

A large portion of insured Americans receive coverage through their employer, usually through managed care plans. These insurance plans work with a specific group of doctors, hospitals, pharmacies, labs, equipment vendors, and other care providers. Individuals insured under managed care plans seek medical services within this managed care network. The three main components of managed care are preferred provider organizations, health maintenance organizations, and point of service plans.

  • HMOs require their policyholders to receive most or all of their medical care under the insurance provider’s managed care network. They also require policyholders to select a primary care physician. If HMO policyholders see a specialist without a referral from their primary care physician, or seek treatment outside of the managed care network, they will most likely have to pay medical bills out of pocket.
  • PPOs also have a network of preferred healthcare providers they request their policyholders to seek treatment from. However, unlike HMOs, individuals do not need to select a primary care provider. Also unlike HMOs, if an individual seeks treatment outside of the managed care network, they can pay the out-of-network healthcare provider directly and possibly get reimbursed for their medical expenses.
  • Point-of-service Plans: Point-of-service plans form a hybrid between PPOs and HMOs. As with HMOs, point-of-service plans allow you to select physicians and services from within a dedicated network of providers. Unlike HMOs, patients can receive care from out-of-network providers, but they will likely have to pay a deductible.

HMOs and PPOs differ in the insurance claim process. All healthcare providers within a managed care network must file a claim with the HMO. So long as services are rendered in-network, policyholders are not required to file anything themselves, and healthcare providers may not bill the policyholder directly. In the case of PPOs, policyholders may have to file a claim to their insurance provider if seeking treatment outside of the managed care network. Filing claims to insurance providers isn’t necessary for POS plans.

Public insurance coverage

The government is also a major provider of insurance coverage in America, through public programs called Medicaid and Medicare.

  • Medicaid is a health service program designed for low-income individuals and families. Medicaid recipients receive health coverage decided by the state in which they reside, though some coverage is federally mandated, such as inpatient and outpatient hospital care. Within this system, states make payments on a fee-for-service system or through arrangements with HMOs.
  • Medicare is another government-funded insurance program for the elderly. Like Medicaid, certain medical services must be covered for Medicare recipients, such as hospital stays and nursing care. This basic coverage is called Medicare Part A. Recipients may also receive coverage in Medicare Part B, also called Supplementary Medicare, for services such as medical equipment, x-rays and labs, and outpatient hospital visits. Recipients of Medicare Part B must pay a monthly premium and pay an annual deductible. There are also Medicare Advantage plans where users can create custom plans that meet their specific needs.

Wrapping Up Course 1

The medical claims process is a dense, complex, but no-less crucial component to the healthcare industry. The following courses will dive deeper into the individual facets of the process referenced in this overview, including coding, insurance providers, medical billing terminology, and medical billing errors. These courses are designed to expand the knowledge base and technical skills needed to become a certified professional medical biller and coder.

How to Become a Certified Coding Specialist #certified #coding #classes #online, #how


How to Become a Certified Coding Specialist

Should I Become a Certified Coding Specialist?

A certified coding specialist. also referred to as a medical coder or health information technician, is a medical professional responsible for overseeing patient records and ensuring bills are paid properly and on time. These medical professionals work as intermediaries who are in contact with the insurance company, billing office and health clinic. They work at hospitals, physicians’ offices, government organizations and nursing care facilities. They spend long periods sitting at desks, on computers. Most coding specialists work full-time and need to serve overnight and weekend shifts.

Career Requirements

Medical billing and coding

Certified Coding Specialist (CCS), Certified Coding Specialist-Physician-based (CCS-P)

Detail-oriented; communication and analytical skills; use of medical software programs

$37,110 (2015 median salary for all medical records and health information technicians)

Sources: U.S. Bureau of Labor Statistics (BLS), job postings (November 2012)

Certified coding specialists have associate’s degrees in medical billing and coding, and they earn certification through the American Health Information Management Association (AHIMA). They are detail-oriented professionals with good communication and analytical skills and the ability to use medical software programs.

According to the U.S Bureau of Labor Statistics (BLS), the annual median salary for medical records and health information technicians, which includes certified coding specialists, was $37,110 in 2015.

Find schools that offer these popular programs

  • Health Care Administration
  • Health Information and Records Admin
  • Health Information Technology
  • Health Management and Clinical Administration
  • Health Unit Coordinator
  • Health Ward Supervisor
  • Medical Administrative Assistant or Secretary
  • Medical Claims Examiner
  • Medical Facilities Management
  • Medical Insurance Billing and Coding
  • Medical Insurance Services
  • Medical Office Computer Technologies
  • Medical Office Management
  • Medical Office Specialist
  • Medical Receptionist
  • Medical Staff Services
  • Medical Transcriptionist

Steps to Be a Coding Specialist

What do I need to do to be a certified coding specialist?

Step 1: Pursue a Postsecondary Education in Medical Billing and Coding

Many coding positions seek individuals with an associate’s degree in medical billing and coding. Courses provide knowledge in medical terminology, reimbursement methods, pathophysiology and commonly used coding systems, including CPT and ICD-9. Students are also taught the details of the Health Insurance Portability and Accountability Act (HIPAA) as well.

Step 2: Gain Work Experience

While work experience is not a requirement to become certified, obtaining 2-3 years of work experience is also highly recommended. Hospitals, clinics, physicians’ offices and insurance companies are common work environments for medical coders. Individuals enrolled in a degree program also have the opportunity to enroll in an internship to gain hands-on training and some recommended work experience.

Step 3: Pursue Certification

The AHIMA oversees the certification exam for aspiring coding specialists. It offers several certification designations, including the Certified Coding Specialist (CCS) and the Certified Coding Specialist-Physician-based (CCS-P). The CCS is geared towards hospital-based coding professionals. Both tests consist of two parts, including multiple-choice questions and patient-case scenarios for medical coding. Both the CCS and the CCS-P exams test on ICD-9 and CPT coding systems. The CCS-P also includes testing on the Healthcare Common Procedure Coding System (HCPCS).

Step 4: Take Continuing Education Courses and Renew Certification

The BLS reported that health information technicians (which include certified coding technicians) need to regularly renew their certification and take continuing education classes. The AHIMA offers seminars, conferences and webinars that provide beneficial experiences for certified coding specialists and meet these requirements. CCSs and CCS-Ps must complete at least 30 continuing education units (CEUs) like these every certification cycle, as well as pay a renewal fee. CEUs are completed through college courses.

Step 5: Consider Pursuing a Bachelor’s Degree

Coding specialists looking to pursue promotional opportunities may need a bachelor’s degree in health administration or a related field, so coding specialists should keep that option open to them if they wish to advance.

Certified coding specialists have associate’s degrees and certification. They use medical software programs while overseeing and updating patient records, and they earn a median annual salary of $37,110.

Next: View Programs

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  • Certification – Medical Billing and Coding Specialist
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    Medical Billing – Coding Schools in Georgia #schools #for #medical #billing #and


    Medical Billing and Coding Schools in Georgia

    Medical Billing and Coding Jobs in Georgia

    Three significant employers of medical billing and coding professionals in Georgia are:

    Atlanta Medical Center

    • Address: 303 Parkway Drive NE, Atlanta, GA 30312
    • Email Address: Use this contact form to email Atlanta Medical Center.
    • Phone Number: (404) 265-4000
    • Website:

    Atlanta Medical Center has been around since 1901. Today, it is a 460-bed tertiary care hospital. It specializes in advanced surgery, neurology, cardiology, orthopedics, women s health, trauma, and rehab. As a member of the Tenet system, Atlanta Medical Center offers great benefits: a 401k, income replacement, medical, vision, dental and life insurance, tuition reimbursement, student loan repayment, an online educational program, paid time off, and an employee stock purchase plan.

    Augusta Surgical Center

    Founded in 1983, Augusta Surgical Center was the first freestanding ambulatory surgical center in Augusta. Services include cosmetic and reconstructive surgery, endoscopic sinus surgery, laser surgery, Gamete interfallopian tube transfer, gastroenterology, infertility treatments, and much more. As an affiliate of Doctors Hospital of Augusta, the Augusta Surgical Center offers a competitive benefits package: dental and vision plans, a flexible spending account, an employee assistance program, short and long term disability, legal assistance, universal life insurance, an HCA 401k, and an employee recognition program.

    Children s Healthcare of Atlanta at Scottish Rite

    • Address: 1001 Johnson Ferry Road NE, Atlanta, GA 30342-1605
    • Email Address: Please use this contact form to email Children s Healthcare.
    • Phone Number: (404) 785-5252
    • Website:

    In 1915, the Scottish Rite Convalescent Home for Crippled Children was founded. Then in 1928, Henrietta Egleston Hospital for Children opened its doors. In 1998, they joined forces, and together the two hospitals became Children s Healthcare of Atlanta. Today, Children s Healthcare employs approximately 150 doctors in 18 locations spread over metro Atlanta for the convenience of their patients. Children s Healthcare offers a nice benefits package: health, vision, dental, life and supplemental term life insurance, a flexible spending account, a health savings account, short and long term disability, leaves of absence, and paid time off, including holidays.

    Top Cities in Georgia for Medical Billing and Coding Careers

    Listed below, compiled with information from the BLS. are the top cities for medical billing and coding employment in Georgia.

    Macon, GA

    There are 170 certified medical billers and coders in Macon, who earn an average of $16.83 an hour or $35,020 a year. The top 10% of workers earns $64,530 — the highest in this list. The bottom 10% earns $22,650.

  • Atlanta Sandy Springs Marietta, GA

    The average annual pay for Atlanta medical billers and coders is $35,200 a year, or $16.92 an hour. The bottom 10% of medical billers and coders in this area makes $22,360, while the top 10% of workers earns $54,400. In addition, this area employs 2,690 workers.

  • Chattanooga, TN GA

    While Chattanooga employs only 300 professional billers and coders, they earn $15.60 hourly or $32,440 annually. The top 10% of employees earns $49,910, while the bottom 10% earns $20,970.

  • Augusta Richmond County, GA SC

    The greater Richmond county area has 330 medical billers and coders who earn an average of $16.59 an hour or $34,510 annually. The bottom 10% earns $20,120 while the top 10% earns $50,440.

  • Athens Clarke County, GA

    Athens employs only 140 medical billers and coders, but they earn $15.94 per hour or $33,150 per year. The top 10% of workers makes $47,750 while the bottom 10% earns $19,600.

  • Gainesville, GA

    The bottom 10% of workers in Gainesville earns $23,680, while the top 10% rakes in a high average salary of $59,730. However, the 60 billers and coders in Gainesville only earn $18.30 hourly or $38,060 annually.

  • Middle Georgia non-metro area

    This region of Georgia is home to 170 medical billers and coders. They earn an average salary of $14.08 hourly or $28,280 annually. The bottom 10% of workers earns a low average annual salary of $17,960, while the top 10% earns $47,250.

  • Rome, GA

    Rome only houses 50 medical billing and coding professionals, but they earn $15.49 per hour or $32,220 a year. The top 10% of workers earns $49,550, while the bottom 10% earns $21,400.

  • Albany, GA

    There are 140 professionals working in Albany, earning an average wage of $12.71 an hour or $26,430 a year, which is a low average salary compared to the other Georgia cities. The bottom 10% of medical billers and coders in this area earns $16,690, while the top 10% makes $39,640.

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    Medical Billing Training Program Red-Flags You Should Avoid #medical #coding #online #classes


    Medical Billing Training Program Red-Flags You Should Avoid

    Updated June 13, 2016

    The good news is that medical billing and other medical record keeping jobs are growing, according to the Bureau of Labor Statistics. More good news is that medical billing can be learned and done from home. However, like other areas of working at home, scammers are duping unsuspecting would-be medical information technicians out of their money and their home-based career dreams.

    Quality online medical billing courses exist and it s easy to learn what s involved and how to find a good program.

    However, by learning the red-flags in questionable programs, you have an additional knowledge to help you weed out the scams.

    Here is a list of things to avoid when searching for a reputable medical billing program.

    1. Programs promoted with a lot of hype, especially with a focus on working at home without a lot of experience.
    2. Programs not taught by by experienced medical billers, medical coders, or a successful medical billing business owner.
    3. Medical billing training offered by educational clearinghouse (school that teaches everything from accounting to zoology). The problem with EC s is that you re not taught the in-depth information you need to be proficient within the medical billing industry.
    4. Programs that insist it takes two years to complete, unless one of the following applies:
      • Your current situation doesn t allow you to dedicated the necessary time to complete the course sooner,
      • Your course also consists of additional subjects such as medical transcription. medical coding or healthcare management,
      • Your course also prepares you to sit for one of the National Certification Exams given by the The American Medical Billing Association (AMBA). The American Academy Of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) .
    1. Training programs that don t cover the essential aspects of doing medical billing including anatomy, medical terminology, coding, insurance rules, and billing software programs.
    2. Medical billing programs that are more than $1,200. However if your course also includes classes on becoming a nationally certified medical coder or medical transcriptionist, then the cost could get as high as $2,500.
    1. Medical billing training is separate from certification, so programs that promise certification should be suspect. After your training, you can get certified, but certification isn t included in training. Note, only three organizations, such as American Association of Professional Coders. award medical billing certifications, which involves a lengthy and extensive exam. When you take a course the most that they can give you is called a Certificate Of Completion which means that you satisfied the requirements of the course and have been awarded the certificate as proof that you did.
    2. Program that don t offer several payment options. Depending on where you take the course (i.e. a community college), you might even be eligible for financial assistance.
    3. Medical billing training that doesn t allow you to speak with past or current students. Not providing references is a red flag.

    When you find a program you like, do your research. Don t be afraid to ask questions, such as how long has the school been around and is it accredited, what is the credentials and experience of the instructors, does the program prepare you for the certification test, what are payment options and is there a refund policy, and is there help in finding jobs or clients?

    If you feel you ve been scammed by a medical billing program, there are a few things you can do, including reporting the program and contacting your payment processor to report the fraud.

    Like other work-at-home industries, the home based medical billing industry has scams and questionable programs. However, that shouldn t keep you from becoming a medical biller. Instead, learn all you can about the industry including how to choose a reputable training program, and how to find legitimate medical billing jobs or start a home business.

    Medical Billing Note From Your Guide

    This article is part of the Medical Billing Guide, a five piece series that looks at the ins and outs of medical billing and coding, both as a career and as a home based business.

    Read more: Medical Billing Guide

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    Top 10 Medical Coding and Billing Schools

    7 Accredited Medical Coding Schools in Tennessee #online #medical #coding #certification


    Find Your Degree

    Medical Coding Schools In Tennessee

    There are 7 accredited medical coding schools in Tennessee for faculty who teach medical coding classes to choose from. The graphs, statistics and analysis below outline the current state and the future direction of academia in medical coding in the state of Tennessee, which encompasses medical coding training at the following levels:

    • Medical Coding Certificate
    • Associates degree in Medical Coding
    • Bachelors degree in Medical Coding


    Arrange By

    340 Plus Park Blvd, Nashville, Tennessee 37217

    N/A U.S. News National University Ranking

    1556 Crestview Dr, Madison, Tennessee 37115

    N/A U.S. News National University Ranking

    500 South Davy Crockett Parkway, Morristown, Tennessee 37813-6899

    N/A U.S. News National University Ranking

    1186 Highway 45 Bypass, Jackson, Tennessee 38301

    N/A U.S. News National University Ranking

    1860 Wilma Rudolph Blvd, Clarksville, Tennessee 37040-6718

    N/A U.S. News National University Ranking

    415 Golden Bear Court, Murfreesboro, Tennessee 37128

    N/A U.S. News National University Ranking

    441 Donelson Pk Ste 150, Nashville, Tennessee 37214

    N/A U.S. News National University Ranking




    Professional Trends

    Tennessee Vs. National Medical Coding Employment

    Of all of the medical coding professionals in the country, nearly 2% are in the state of Tennessee.

    Employment Growth for Medical coding professionals In Tennessee

    This represents a growth in salaries of 15%. This growth is mirrored by state trends for all professionals. In the state of Tennessee, there is a huge variation in pay, within the field of medical coding. The pay differential between the highest paid medical coding professionals and those in the bottom 10% of the pay bracket is 139%

    Average Salaries for Medical coding professionals and related professions in Tennessee

    Health Information Management

    In Tennessee, medical coding professionals make, on average, less than their counterparts in related professions.

    Educational Trends

    Medical Coding programs available for each degree type for all schools in Tennessee

    As the number of medical coding professionals is decreasing in Tennessee state, the number of students graduating from the 7 accredited medical coding schools in Tennessee state is increasing. In 2006, 12 students graduated from medical coding courses in Tennessee. And in 2010, 170 students graduated.

    Thus there was a 1317% percent increase in the number of medical coding school degree or certificate graduates in Tennessee. A majority of these graduates, or 50%, graduated with a undergraduate certificate in medical coding.

    Medical Coding Faculty Salaries in Tennessee

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    Enter your salary to gain access to our continually growing higher education faculty salary database. Don’t worry! This is 100% secure and anonymous.

    We are now in the process of collecting data for the number of medical coding faculty in Tennessee, growth in the field of medical coding academia and medical coding faculty salaries in Tennessee. If you are involved in teaching medical coding courses to students at the certificate in medical coding, associates degree in medical coding, and bachelors degree in medical coding levels, please take a moment to anonymously submit your information to help us build a valuable database resource for the benefit of current and future faculty in the field of medical coding in Tennessee. Once you submit your information, you will get a chance to see the data we have collected thus far.

    Related Links

    Online Medical Billing and Coding Schools #medical #billing #and #coding #online #school


    The Cutting Edge of Medicine Medical Billing and Coding

    Browse Schools that offer online Billing/Coding

    article continued from above.

    Billing and coding continues to be a great career opportunity, with pay being considered generous for an entry level job. However, trying to educate yourself through methods that avoid college courses or classes may not be the best method of insuring that you will have a job once you have the knowledge. The two terms “billing” and “coding,” actually involve two different jobs which are often performed by the same person. Medical billing involves collecting data for all aspects of a claim, helping to make sure the medical facility is performing efficiently. Coding, on the other hand, is the application of the correct code to every medical procedure used in a particular case. Without correct codes, the insurance companies are unable to make correct, speedy payment. Both jobs require knowledge of medical procedures, anatomy and terminology along with an understanding of how the insurance industry operates.

    The medical field has evolved dramatically over the past 10 to 15 years alone. The arrival of the Affordable Care Act has resulted in complex levels of medical coding; the new CD-10 has changed to available codes from just over 13,000 to 144,000. If the wrong code is entered on a bill, the doctor stands to lose thousands of dollars, both in the cost of refiling and in fines and reductions in payment from the insurance company. In fact, it is possible for a physician to lose his practice because of coding errors. As for lost revenue, Ruthann Russo. executive director of HP3 Healthcare Concepts, says that a review of one 200 physician multi-specialty group revealed that an estimated $10 million was simply lost because staff involved had not correctly billed the services.

    Get Educated

    These changes actually mean that billing and coding is as great a career opportunity as ever; in fact one national survey reports that there are 30% more positions than there are people to fill them, and the shortage is expected to increase. But doctors can no longer afford to take a chance on people who claim to know the business but have no formal training. Doctors are urged to hire personnel with AHIMA or APC certification, who have taken courses with AHIMA approved trainers. You may be expected to take courses in Health Information Management, Pharmacology, and Legal compliance as well as the courses in coding. However, don’t feel overwhelmed. Many schools have designed their programs to be completed in as little as four months. Those who complete the course work, a practicum, and pass the test receive certification and are considered billing and coding specialists.

    Use our convenient service to research the education programs and get started on your own billing and coding career.

    Get Paid

    The pay for a billing/coding specialist varies from state to state but according to the BLS. the mean annual wage for Medical Records and Health Information Technicians overall, is about $38,860.

    Popular Degrees

    Associates degree in medical billing and coding #associates #degree #in #medical #billing


    Lsu’s Medical Coding Certificate Program

    LSU Independent And Distance Learning
    Are you interested in a program that enables you to achieve your educational goals without having to give up other enhance your professional credentials, or simply expand your educational horizons, LSU Independent Distance Learning (IDL) may be the program you are looking for. To Read More

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    Medical Billing and Coding Certificate Programs in Florida #online #medical #coding #certification,


    Medical Billing and Coding Certificate Programs in Florida

    Find schools that offer these popular programs

    • Health Care Administration
    • Health Information and Records Admin
    • Health Information Technology
    • Health Management and Clinical Administration
    • Health Unit Coordinator
    • Health Ward Supervisor
    • Medical Administrative Assistant or Secretary
    • Medical Claims Examiner
    • Medical Facilities Management
    • Medical Insurance Billing and Coding
    • Medical Insurance Services
    • Medical Office Computer Technologies
    • Medical Office Management
    • Medical Office Specialist
    • Medical Receptionist
    • Medical Staff Services
    • Medical Transcriptionist

    Essential Information

    Medical billing and coding professionals assign the correct codes to patients’ medical records to assist with billing and reimbursement. Training in medical coding and billing can be found through certificate, diploma and associate degree programs at community colleges and technical schools. Coding instruction typically focuses on learning the International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) coding systems.

    Atlantic Technical College

    Located in Coconut Creek. Atlantic Technical College offers a 10-month medical biller/coder program that prepares students for entry-level employment in medical facilities. Students gain instruction in ICD-CM coding, disease processes, medical terminology, advanced coding and pharmacology. After completing this 1,000-hour program, students receive an Applied Technology Diploma and are eligible to take certification exams for the Certified Coding Associate (CCA) and Certified Coding Specialist (CCS) credentials from AHIMA, as well as the Certified Professional Coder (CPC) credential from AAPC. In addition they can earn the Florida Ready to Work credential, which is a state certification used to establish employment readiness. Students may also transfer 26 credits towards a health information management associate degree program at Broward College.

    Brevard Community College

    The medical information coder/biller program at Brevard Community College in Cocoa is offered on a full- or part-time basis. The 34-credit program has limited admissions, so interested applicants need to meet all requirements. Students take courses in pharmacology, microcomputer applications, hospital coding and billing, computerized physician office billing and CPT coding principles. A practical work experience provides students with the chance to work in a healthcare setting. Graduates are prepared to obtain national certifications such as CCA and CPC credentials.

    Hillsborough Community College

    Tampa -based Hillsborough Community College (HCC) offers two 34-credit technical certificate programs in medical billing and coding, as well as an office administration associate degree program with a medical office administration specialization that includes coding coursework. Students choose the appropriate technical certificate program depending on whether they wish to focus on medical coding or medical billing. The programs prepare students for positions such as medical coders, medical billers or medical office specialists.

    A clinical practicum provides students with hands-on training in a medical setting. Courses can be transferred to the associate degree program. The college also offers a certificate program in medical office management that includes some instruction in medical billing.

    Students pursuing the degree program must also complete general education courses, as well as a practicum in billing and one in coding. Topping off the 63-credit hour program is an internship in HCC’s Office Systems Technology Department. Graduates of this program are eligible for certification exams and management-level careers in medical offices.

    Lindsey Hopkins Technical Education Center

    Lindsey Hopkins Technical Education Center in Miami offers a medical coder/biller program that can be completed in 11 months. The 1,000-hour curriculum consists of four courses, including a 90-hour course in health information technology and three sequential medical coder and biller courses. Students are accepted into this program every six months. Applicants take an assessment test and participate in an interview. Those who have withdrawn from high school can apply if they are at least 16 years of age.

    Manatee Technical Institute

    Manatee Technical Institute in Bradenton offers a medical coder/biller program that can be completed in less than a year if attending full-time. Through classroom studies and practical experiences, students gain the skills for positions in medical facilities and obtain preparation for the CCA certification exam. Students learn about medical terminology, basic data processing, safety and security procedures, healthcare delivery systems and pharmacology. Students completing this program can transfer credits towards a health information management associate degree program also offered at Manatee Tech.

    Pasco-Hernando Community College

    Students completing the medical coder/biller program at Pasco-Hernando Community College in New Port Richey earn applied technology diplomas and can seek work as medical coders and billers. If students attend full-time, they can complete this 33.33-credit program in a year. Also offered at the North Campus in Brooksville and the East Campus in Dade City. this program offers a curriculum of medical courses and clinical education. The program requires that students complete a four-hour AIDs seminar and also have CPR (Basic Life Support for Healthcare Providers) certification. Applicants must have adequate TABE (Tests of Basic Education) scores.

    Pinellas Technical Education Centers

    The Saint Petersburg campus of Pinellas Technical Education Centers offers a medical coder/biller program through distance learning. The 1,000-hour program includes a curriculum of four sequential courses. After taking a health information technology course, students focus on medical coding and billing in three courses. Completing this one-year program qualifies students to sit for the Certified Billing and Coding Specialist (CBCS) credential from NHA and the Certified Coding Associate (CCA) certification from AHIMA. Additional certifications are available to graduates once they obtain work experience.

    Sheridan Technical Center

    The 1,000-hour medical coding/billing program at Sheridan Technical Center in Hollywood offers evening classes Monday through Friday. The program covers the CPT and ICD-9-CM coding systems and introduces students to electronic health records and health informatics. Topics of study include medical terminology, pharmacology, manual and computer coding, disease processes and ethical issues. Students that successfully complete this program earn applied technology diplomas.

    Career Requirements

    According to the U.S. Bureau of Legal Statistics, certification may be a requirement for most employers. Aspiring medical coding and billing specialists who want the advantage that gaining certification can offer can apply for various credentials. These include certification from agencies such as the American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA) or the National Healthcareer Association (NHA). Applying for certification is an option after graduation from one of these eight Florida schools.

    School Comparison: At a Glance

    Medical Coding Certificate FAQ – School of Informatics and Computing: IUPUI #how


    Medical Coding Certificate FAQ


    For whom is the program intended?
    The program works well for those who would like to work in a healthcare setting, but not in direct contact with patients. The program can be a great fit for any student looking for flexibility in a profession with a strong attention to detail and organization.

    What is a Medical Coder?
    A medical coder is an individual who reads information in the patient health record, extract pertinent diagnoses and procedures, and assigns medical codes to each medical diagnosis and procedure. Once fully coded, the medical coder sends the record to the medical biller for reimbursement purposes.

    What are the admission requirements?
    Prospective students must first be admitted to IUPUI as an undergraduate student. Upon acceptance to IUPUI, students must complete prerequisite courses including anatomy, physiology and database design. Students must earn a minimum grade of a C in each class with a cumulative grade point average (GPA) of 2.5 in order to take the coding core classes.

    Do I need to take the ACT or SAT?
    The Medical Coding Certificate program follows University policy when the student is admitted to the University/School of Informatics and Computing. For more information visit: Office of Undergraduate Admissions

    Who are the faculty for the program?
    Courses in the Medical Coding program are taught with rigor by our top Health Information Management (HIM) Medical Coding experts. The HIM faculty will be your guide for completing course assignments, meeting course objectives and participating in eLearning activities.

    What courses are required?
    Required courses include medical terminology, pathophysiology, pharmacology, coding, medical reimbursement and basic concepts of health information. The Medical Coding Certificate courses are designed to better prepare students to sit for industry standard certifications.

    How long does it take to complete a Medical Coding Certificate?
    It will depend on how many courses you take each semester. If you take a full credit course load, it would be possible to complete the certificate program in as little as nine months. Courses are offered every semester.

    How long do I have to earn my degree?
    The Medical Coding Certificate program follows state and federal requirements regarding program completion deadline. For more detailed information visit: Office of Student Financial Services

    Will I be able to get professional experience in my classes?
    There is a coding practicum course that is a requirement of the Medical Coding Certificate which provides students with hands-on industry experience.

    Is Financial Aid or scholarships available?
    Students are encouraged to visit the IUPUI Financial Aid Office at Office of Student Financial Services as well as SOIC Undergrad Financial Aid Scholarships for more information.

    What jobs opportunities are there once I graduate?
    A Certificate in Medical Coding can be the foundation for a variety of positions, including:

    Are employers hiring in this profession?
    According to the Bureau of Labor Statistics, employment of health information managers which includes medical coding, is expected to grow 22 percent from 2012 to 2022, much faster than the average for all occupations. The demand for health services is on the rise as the healthcare system goes digital, the ICD-10 coding system is implemented, and the population ages. There are approximately 12,000 to 50,000 new jobs anticipated by 2017.


    Is the Medical Coding Certificate program at IUPUI accredited?
    CAHIIM accredits Health Information Management (HIM) Associate, Bachelor, and Master degree programs along with administering credential certification exams for Health Information Management (RHIA) and Medical Coding (CCA) programs. Upon completing our Medical Coding Certificate, students are able to sit for CAHIIM’s Certified Coding Associate certification exam.

    Certified Coding Associate (CCA) Examination
    Medical Coding Certificate graduates are eligible to seek the Certified Coding Associate (CCA) credential offered by the American Health Information Management Association (AHIMA) .

    Enrollment, Credits and Transferability

    When is enrollment open?
    Students may enroll during open enrollment each spring and fall. For more information visit: Office of the Registrar

    How many credits are required for the program?
    The Medical Coding Certificate is a 26-credit-hour program. All courses must be completed with a grade of C or higher to count towards degree completion. The core courses are available online with some offering an on campus option. Credit earned for the certificate may be applied toward the Bachelor of Science degree in Health Information Management (application and acceptance into the Health Information Management (HIM) program required).

    How do I know whether my credits will transfer?
    Transcripts are reviewed by the IUPUI admissions advising professionals for transfer credit.

    Do you have an option for advanced placement or testing out of classes?
    Credit for applicable work experience or completion of college level classes may be available according to University policy. For more information visit: University College Orientation Services or Office of Undergraduate Admissions


    Is this an online program?
    Coursework may be a combination of on campus and online classes.

    Are online courses right for me?
    Online classes offer flexibility to study while still having time to work and accommodate other life commitments. Those taking online courses use technology to communicate with classmates and instructors. In order to be successful in online classes, students should be self-motivated and able to handle their time wisely. Online courses have little to no face-to-face interaction with instructors and other students, but there is a classroom and instructor (theoretically) available 24 hours a day.

    Can I complete the certificate if I live out of state?
    Out of state students may complete the online classes. For the classes that are offered on campus, academic advisors work with students to ensure equivalent courses are being taken at local universities.

    Will I need special equipment to take online classes?
    Learning and completing your coursework requires access to a desktop or laptop computer and Internet access. IUPUI provides 24 hour technical support if you need technical support while doing coursework.

    Coding Practicum Information

    What is a professional practicum?
    The practicum provides professional experience in an approved clinical site under the direction of an HIM faculty member and an onsite clinical instructor. Students also receive didactic and practicum experience in the classroom with emphasis on medical coding and reimbursement systems. Certificate students take the practicum during the last semester of the program.

    What is the required length of time I will spend at my practicum site?
    A minimum of 8 contact hours is required per semester at the site.

    Am I responsible for finding my practicum site or does the Medical Coding Certificate program staff find the site for me?
    The instructor works to find clinical sites for all students. Some students have site preferences or community contacts that they would prefer to use. Students are free to find their own site if they choose, otherwise a site will be assigned.

    What documentation is required before I go to my practicum site?
    Requirements vary by site. Some sites may require a physical exam, immunizations, and/or background checks before beginning any phase of the practicum experience. You may also be required to purchase and furnish a professional liability insurance policy.

    Am I permitted to do my practicum experience at my current place of employment?
    Yes, students may complete their practicum at their place of employment. However, the student would need to be assigned to a different work area or perform a project other than their normal duties for the practicum.

    If I am employed in healthcare as a Coder, do I still have to complete the practicum?
    Potentially the practicum could be waived as credit for applicable work experience according to University policy. For more information visit: Office of Undergraduate Admissions

    Fulfilling the Promise

    Accredited Medical Billing And Coding Online Courses – The Medical Coding Schools


    Online Medical Billing and Coding Programs For 2016
    Find medical billing and coding programs, certification and more. Explore videos, curriculum, salary information, and the top online schools. Everything you need to get started in Medical Billing Coding. About MB C; Resources; Salary; Schools; States; Q A;

    Medical Billing and Coding Online | Penn Foster Career School
    online Medical Billing and Coding program all from the comfort of your own home. Penn Foster Career School s regionally and nationally accredited online Medical Billing and Coding training program is Penn Foster Career School s online coding courses are aligned to

    AHIMA / CAHIIM Accredited Online Medical Coding Schools
    AHIMA / CAHIIM Accredited Medical Billing Coding Your guide to AHIMA / CAHIIM accredited medical coding and health information education. CAHIIM Accredited Coding Programs

    Distance Education Programs, Accredited Online Programs
    We have a wide variety of accredited online programs for you to choose from in the growing business and allied health the courses are delivered through an online classroom. The average time to complete a diploma program in medical billing, medical coding, medical coding and billing,

    Accredited Online Medical Billing and Coding Colleges
    Accredited Online Medical Billing and Coding Schools and Degree Programs. Accredited Online Colleges Database. Search by College Name But it s worth noting that some of these schools allow interested students to take a portion of their courses on campus.

    Allied Schools | Accredited Online School Career Training Courses
    Get quick and affordable real estate and medical career training courses. Live support. Apply now! Home; Courses; Financing; Why Allied; Contact; FAQ; Online Communities Medical Coding Program | Medical Assisting Program Allied Schools is a nationally accredited online school that

    Accredited Medical Billing and Coding Program Penn Foster
    online Medical Billing and Coding program. Student Login; 1-800-471-3232; For Educators; Individual College Courses; College Reviews; Accreditations and Affiliations; Penn Foster Career School is accredited by the Distance Education Accrediting Commission

    Medical Billing and Coding Online Course Ashworth College
    Enroll in Ashworth College medical billing online courses, get trained and prepare for and industry leading Medical Billing and Coding Certification online by NHA. (NCCA) nationally accredited certifications.

    Accredited Billing and Coding Schools
    6.01: Accredited Billing and Coding Schools. Both of these professional organizations offer courses in medical billing and coding. they can t be accredited. Taking courses from these organizations can be expensive, though,

    Medical Billing Coding Specialist Certification | Online
    Medical Billing and Coding: An Exploding Home Career Opportunity. many are finding that a Medical Billing and Coding career is the ideal work-at-home job. 2016 All Rights Reserved. Home;

    Online Medical Billing and Coding Schools | Classes/Courses
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    Online Medical Billing and Coding School
    then there s no need to look any further than our online medical billing and coding school. This combination of our popular online Medical Billing and Medical Coding Specialist programs will prepare you for a career in a professional medical office as a Medical Coding and Billing Specialist.

    HIM Careers Coding Education Programs
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    Accredited Online Medical Billing and Coding Diploma Program
    Our Medical Coding and Billing online courses will give you the skills and specific expertise you need to become successful in this quickly growing, The total price for the Brighton College Medical Coding and Billing program is

    The Best Online Medical Coding Billing Schools Of 2016
    Search the best online medical coding and billing schools of 2016. Compare programs and tuition costs to decide if an online Ultimate Medical Academy is accredited by the Accrediting Bureau of Health Education Schools and is a member of the Association of Private Sector Colleges and

    Medical Billing and Coding Certification | Drexel Online
    Earn your Medical Billing and Coding Certification 100% online with Drexel University s accredited degree The accredited Certificate in Medical Billing and Coding program is a fully Drexel s online medical billing and coding courses focus on the four most commonly used coding

    Medical Billing And Code Certificate Program Online | DeVry
    DeVry s Medical Billing Coding Certificate program offers students the necessary skills for a career in medical billing. DeVry University offers the flexibility of online courses; DeVry University is accredited by The Higher Learning Commission

    Certificate In Medical Billing and Coding | College Of
    The Certificate in Medical Billing and Coding is a fully-accredited online, Fully accredited by Middle States Association of Colleges and Secondary Schools; Flexible as the courses are all online you need never come to campus and can complete it at your own pace;

    Medical Billing and Coding Courses | Allen School Online
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    Medical Coding Medical Billing Medical Auditing AAPC
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    Top 10 Medical Coding and Billing Schools

    Home Health and Hospice – OASIS-C1, home health regulations and reimbursement, home

    #beacon hospice


    Home Health & Hospice

    Beacon Institute Resources

    Top Stories

    This is allowed, per Chapter 7, since eligibility has been confirmed. Now, if something happens and the qualifying service never had a chance to see the patient, there would be no payment. The following is from Chapter 7:

    The ability to show the impact of care begins with an accurate assessment at the beginning of the episode. According to the Medicare Conditions of Participation (CoP 484.55), A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. In cases that include nursing and therapy services, the registered nurse is required to complete the admission visit regardless of patient diagnosis or staffing availability. CoP 484.55 goes on to add, When rehabilitation therapy service (speech language pathology, physical therapy, or occupational therapy) is the only service ordered by the physician, and if the need for that service establishes program eligibility, the initial assessment visit may be made by the appropriate rehabilitation skilled professional.

    In this week’s roundup:

    • Home health class lawsuit denied. Collective action lawsuits have increased since federal overtime laws that affect home health care workers and their overtime have come into effect.
    • Public-private partnership of remote patient monitoring hints at patient satisfaction. Two years ago, the Visiting Nurse Association launched its remote patient monitoring (RPM) project, which targeted a congested heart failure population with extremely high hospital readmission rate.
    • Stakeholders: Home health ‘PPS’ spells ‘pay cut’ (again) for CY 2017. CMS’ proposed changes for the Medicare Home Health Prospective Payment System (HH PPS) for Calendar Year (CY) 2017 include the expected a reduction in payment but nothing that will turn the home health benefit upside down.
    • Amedysis founder dies in floods. Amedisys Inc. one of the largest home health companies in the nation, has suffered greatly after the flooding in and near Baton Rouge, Louisiana: The company s founder and former CEO, William Bill Borne, 58, die in the floods.

    Read full stories.

    You can use ranges on hospice patients. Missed visits are only needed if the agency does not meet the minimum of the range so in this example, you would only notify the physician if the patient was not seen at least once in a month.

    When our patients are admitted to an inpatient facility and we complete a transfer OASIS, we normally will choose not to discharge the patients and await their return home, resuming care at that time. We have a question about what happens if a patient dies while hospitalized and now needs to be discharged from home health. When we enter our discharge reason for home health, is it that the patient was transferred to an inpatient facility, or is the discharge reason that the patient expired?

    Federal and state regulators as well as private payers are working hard to curb the costs of Medicare and Medicaid programs. Although the vast majority of hospice providers are operation within the law, regulators have identified some bad actors. For example, a recent Office of Inspector General (OIG) study of hospice care in ALFs raised concerns about the possibility of hospices focusing on certain types of patients under the current payment system. The OI study concluded that hospices have financial incentives to serve patients in ALFs because these patients tend to have diagnoses associated with longer stays (such as ill-defined conditions, mental disorders, or Alzheimer s disease) that often require less complex care and result in higher payments per patient for the provider.


    Welcome to the Beacon Institute

    Have a question that you need answered clearly and correctly? As a member of the Beacon Institute, our panel of experts will fully research complex, homecare specific questions for you. Click here to ask your question.

    Video Loan Library
    Premium Beacon Institute members receive 10 training video loans per annual membership term. Click here and look under Videos to see what we offer. Request a video here.

    Beacon Connect
    Beacon Connect connects you with fellow members of the Beacon Institute across the country. A members-only feature, this online talk group allows members to voice their opinion, share tools and policies, and receive answer to industry-related questions from their peers. Click here to connect

    Surgical Technology #university #of #scranton,marywood #university,marywood,keystone #college,keystone,johnson #college,johnson,itt #technical #institute,itt #tech,mccann #school


    Surgical Technology

    Coming to Scranton for Fall 2017!

    Lackawanna College’s Surgical Technology Program is designed to be completed over a two-year period with day, evening, and Saturday courses as well as on- and off-campus clinical hours. Each program also includes summer session courses and clinical lab hours.

    Acceptance into Lackawanna College’s Surgical Technology Program is based on a selective admissions process with a maximum of 15 students selected annually.

    Degree information

    Through a balance of classroom instruction and clinical experience, the student will acquire applied skills and knowledge in the field of Surgical Technology.

    Surgical technologists work in the operating room under the direct supervision of a surgeon and a registered nurse. Surgical technologists help facilitate the draping, and prepping of the surgical patient. They gown, and glove other team members. They get all the instruments, supplies, equipment necessary for specific surgical procedures. As a member of the sterile team, surgical technologists will hand all necessary instruments and supplies to the surgeon and other team members.

    A surgical technologist has a broad knowledge of anatomy and physiology, microbiology, sterile techniques, and patient safety concepts as well as ethical and legal concepts. A surgical technologist must have an understanding of the hospital organization, policies, and procedures.

    Job opportunities and salaries in the healthcare specialty of surgical technology have been rising steadily over the last few years, and the U.S. Department of Labor predicts employment of surgical technologists is projected to grow 30% from 2012 to 2022, much faster than the average for all occupations. Advances in medical technology have made surgery safer, and more operations are being done to treat a variety of illnesses and injuries. The median annual wage for surgical technologists was $41,790 in May 2012.

    Most surgical technologists are employed by hospitals, day-surgery centers with the remainder working in the offices of physicians. After two years of experience, a certified surgical technologist may apply to become a traveling surgical technologist.

    Lackawanna College’s Surgical Technology program combines classroom instruction with practical clinical externships at local hospitals. Both career-specific and academic core courses are included. Students successfully completing the program are eligible to sit for the National Certifying Exam (CST).

    Surgical Technology Program classes are given days, nights and on weekends (based on the availability of the instructors). Clinical externships, however, must take place during the daytime.


    • To give students an understanding the need for surgical intervention
    • To develop an understanding of the role of surgical technologist as a member of the surgical team
    • To instruct students in the responsibilities which the performance of this role entails
    • To assist students in developing the knowledge of the organizational structure of the hospitals, its departments and the operating room
    • To develop a basic understanding of biological science as it relates to safe operating room procedure
    • To facilitate the hands-on, supervised experience in the operating room performing the duties of a surgical technologist.

    OAE-CST Pass Rate

    Annual reporting year

    Admissions criteria and requirements

    Prospective students must meet the college’s minimum requirements. Applicants must submit proof of high school or GED completion with official high school transcript or GED equivalent. Lackawanna College will determine the applicant’s current academic ability based on a combination of following:

    • SAT or ACT test scores, if applicable
      • Recommended SAT scores: 470 Verbal and 470 Math.
      • Recommended ACT scores: 20 or higher in each relevant section.
      • Most scores are valid up to 3 years from test date.
    • College Transfer Credits
      • If transferring credits from another college/university, official college transcripts are required.
    • Placement Test
      • Applicants without valid SAT/ACT scores and who have not previously earned college credits will be required to take the ACCUPLACER exam for determination of current academic ability. Applicants must achieve College Ready scores in Reading, Writing, and Math to be considered qualified for the Surgical Technology program.

    Due to the very specific nature of these degree programs, applicants with transfer credits may only transfer credits related to program core courses including the following:

    • Anatomy and Physiology I – 4 credits
    • Anatomy and Physiology II – 4 credits with lab (if taken within two years)
    • College Algebra
    • Computer Applications
    • College Writing
    • Effective Speaking
    • Introduction to Psychology
    • Medical Ethics (subject to review)
    • Medical Terminology (subject to review)

    Items for official placement into program

    • $100 commitment fee
    • Official high school transcripts
    • Official college transcripts
    • SAT/ACT scores, if applicable
    • FAFSA
    • CPR Certification
    • FBI Clearance
    • State Clearance
    • PA Child Abuse Clearance
    • 2 Step PPD
    • Recent Physical Examination
    • Copy of Immunization Records
      • Varicella Vaccination Date or Date/Year of Chicken Pox
      • Hepatitis B vaccination (3 shots) or waiver
      • MMR documentation or titers
      • Adult TDaP (after age 19)

    Interviews will be scheduled for qualified Surgical Technology program applicants who submit a fully completed application. A mandatory informational meeting will be required prior to start of the selected program.Qualified students will be notified of the date and time upon selection into program. The meeting will review the Surgical Technology department’s policies and expectations. The meeting will also allow for question and answer session and tour of the Lackawanna College facilities.


    Changes in the curriculum for this program have been approved by ARC/STSA and will be in effect for students beginning their studies in the Fall 2017 cohort.

    This degree program is moving to our Scranton campus in Fall 2017.

    ICD-9-CM Procedure Codes #medical #billing #coding #program


    ICD-9-CM Procedure Codes

    The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates that Volume 3 of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) be used to code inpatient services on medical claims.

    While most professional medical coders and medical billers use the diagnosis codes in ICD-9-CM every day, the code manual also contains a series of codes used to describe medical procedures. All editions of ICD-9-CM contain Volume 1 and Volume 2. Expert editions of ICD-9-CM, designed for use by hospitals and payers, also contain Volume 3, which is dedicated to procedural coding.

    Because Volume 3 codes are used exclusively in the inpatient setting, certified medical coders who are fluent in using them are specialists in their field. Medical billers and medical coders who do not use these code sets regularly have still been trained in their use. A solid, well-rounded education is what professional medical coders and billers bring to their jobs, applying a consistent philosophy to coding that governs every medical claim for payment.

    Organization of ICD-9-CM Volume 3

    ICD-9-CM procedure codes are two numeric digits followed by a decimal, which is then followed by another one or two digits. The codes begin with 00.01, to describe a therapeutic ultrasound of vessels in the head and neck, and they end with 99.99, which describes other miscellaneous procedures. ICD-9-CM indicates that leech therapy falls under 99.99. Being able to read and understand the code manual is an asset for hospitals to submit accurate claims for accurate reimbursement.

    The majority of Volume 3 of ICD-9-CM is arranged by anatomical location. After the codes that start with 00, which cover procedures and interventions not classified elsewhere in Volume 3, the codes run in progression to describe procedures and interventions at different sites and through different constitutional systems. Codes that begin with 01 through 05, are defined as operations of the nervous system, while codes that begin with 06 or 07 are operations of the endocrine system.

    Like Volumes 1 and 2, ICD-9-CM Volume 3 provides specific definitions of each procedure being described. For example, 06.2 is used to describe a unilateral thyroid lobectomy. ICD-9-CM makes a point of saying that 06.2 should not be used to describe a partial sub-sternal thyroidectomy, which is more accurately described by 06.51. The isthmus is not considered a lobe, and when the isthmus is removed, the code used to describe that procedure is 06.39.

    By understanding the terminology employed in ICD-9-CM, and by understanding the documentation in the patient’s medical record, certified medical coders assign the code that matches what was performed. Being able to bear all the code variations in mind while reviewing medical records and assembling claims, professional medical coders and medical billers reduce fraud and abuse of the healthcare reimbursement system, limiting a hospital’s legal exposure to charges of the same.

    Uses of ICD-9-CM Procedure Codes

    The Center for Medicare and Medicaid Services (CMS) which administrates the implementation of HIPAA, has offered clear guidance that Volume 3 procedure codes are only to be used in the inpatient setting to obtain reimbursement. CMS states that hospitals can use Volume 3 codes for internal tracking purposes, but the HIPAA standard is to use Healthcare Common Procedure Coding System (HCPCS) codes in every other setting when financial transactions take place with third-party payers.

    Not all procedures that are performed in a hospital are inpatient services. Patients who receive services on an outpatient basis, such as walk-in laboratory tests, have their healthcare claims submitted with HCPCS codes to describe the services received. Inpatients are patients who are admitted to the hospital and stay at least overnight. Patients can be admitted to a hospital overnight solely for observation. Any services these patients receive are described by the use of HCPCS codes because they do are not in an inpatient treatment status.

    All procedure codes are attached to specific charges that a hospital has determined represents its reasonable cost to perform the service. Hospitals are paid according to Diagnosis Related Groups (DRGs) for inpatient services, but diagnosis codes are not, themselves, associated with charges. By using ICD-9-CM Volume 3 codes, hospitals establish the amount owed for a specific inpatient encounter, while the DRG assigned to the patient’s inpatient stay determines the payment.

    By reporting ICD-9-CM procedure codes, and their associated charges, Medicare, Medicaid, and other third-party payers can examine past claims and adjust the DRG reimbursement rates according to the costs incurred. Accurate coding affects not only a specific medical claim, but also the reimbursement system as a whole when all the claims are analyzed in aggregate.

    Appropriate Use of ICD-9-CM Volume 3

    In the medical office setting, most billing software is loaded with a database of the complete set of ICD-9-CM codes, both diagnostic and procedural. Even if they are not appropriate, Volume 3 codes are available to medical billers and medical coders in the outpatient setting.

    Properly trained and certified medical coders and professional medical coders recogize the difference between Volume 3 codes and HCPCS codes. They also recognize the difference between ICD-9-CM codes that have two primary digits and those that have three. Those that have two primary digits are procedure codes that have no place in any setting that is not inpatient care.

    Inexperienced medical coders, including physicians and other healthcare providers, are tempted to use Volume 3 codes because the codes do accurately describe services. An outpatient medical claim, a claim from a Skilled Nursing Facility (SNF), or a claim from an Ambulatory Surgery Center (ASC), does not make sense when it contains Volume 3 ICD-9-CM codes. The claim will be denied coverage and payment because the coding language used cannot be deciphered in this particular situation. It will need to be recoded and resubmitted, costing man-hours and lost time to recoup the correct reimbursement.

    With training from a formal, credential program, professional medical billers and certified medical coders recognize when specific coding systems should be used. There are rules to assigning medical codes that are established by federal statute, such as HIPAA, as well as by the Patient Protection and Affordable Care Act of 2010 (PPACA).

    As the provisions of the PPACA come into effect, the regulatory atmosphere surrounding medical coding will become more complex. PPACA mandates that ICD-9-CM be replaced by ICD-10 in 2013. Medical coders and billers who have a solid understanding of ICD-9-CM are expected to make a smooth transition to the new coding system. ICD-10-CM, which will replace Volume 1 and Volume 2 of ICD-9-CM, and ICD-10-PCS, which will replace Volume 3 of ICD-9-CM.

    Both the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) predict that minimal training will be needed for experienced medical coders and medical billers to make the switch from ICD-9-CM to the more specific, and extensive. ICD-10 system. With the PPACA deadline approaching, employers are looking for personnel with formal credentials to fill medical billing and coding openings. Formal education is viewed as evidence that billers and coders can master the material needed to perform their jobs accurately and effectively, in order to obtain maximum legal reimbursement for provided services.

    Coding and Billing Information – Centers for Medicare & Medicaid Services #uk

    #home health service


    Coding and Billing Information

    Home Health PPS Coding and Billing Information includes:

    • HH PPS HIPPS code weight table – See Downloads section below. These spreadsheets map each of the 1836 HIPPS code for the HH PPS to its associated case-mix weight.
    • Home Health PPS Grouper Software and Documentation – See Related Links Inside CMS below.
    • Health Insurance Prospective Payment System (HIPPS) Codes – See Related Links Inside CMS below.
    • Home Health PC Pricer – Program used by CMS to calculate Home Health Resource Group (HHRG) rates and all applicable adjustments. The link below also includes a user manual for the program. See Related Links Inside CMS below.
    • Home Health Consolidated Billing Master Code List – An Excel workbook file containing complete lists of all codes ever subject to consolidated billing provision of HH PPS. A master list worksheet shows the dates each code was included and excluded from consolidated billing editing on claims, with associated CMS transmittal references. The master list also associates each code with any related predecessor and successor codes. Supplemental worksheets show the list of included codes for each CMS transmittal to date. See Downloads section below.
    • Home Health PPS Wage Index Files – See Downloads section below.


    Related Links



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