Capstone Checkpoint - information about procedures HCPCS...

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Submitting claims to insurance companies requesting reimbursement for provided medical services is called the medical billing process. There are ten steps that make up to process starting with pre-registration, establishing financial responsibility, checking the patient in, checking a patient out, reviewing for coding compliance, verification of billing compliance, the preparation and transmittal of claims, monitoring of payer for adjudication, the generation of patient statements, and the follow-up of payments by the patient as well as handling collections. HCPCS, HIPPA, CPT, and ICD influence every step of the billing process. The 9 th Revision-Clinical Modification (ICD-9-CM) is a global categorization of disease and contains codes that pertain to these diseases. These codes are responsible for even measures and diagnosis. The ICD-9 code has three digits, which can be followed by a decimal, and then two more digits. The Healthcare Common Procedure Coding System (HCPCS) does not provide diagnosis information only
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Unformatted text preview: information about procedures. HCPCS codes main purpose is to process treatments in hospitals and for outpatient services. Physicians also utilize these codes. ICD-9 codes are required by HIPPA for the purpose of reporting procedures. A medical coder or biller assigns the numerical CPT and diagnosis codes. They are able to determine these codes by the documentation of the provider. A charge is then created that follows the billing rules according to the health insurance plan. People who handle personal healthcare information are required to maintain the confidentiality of patient information based on HIPPA rules. Employees must be honest and conduct themselves in a professional manner to ensure that billing compliances are met and patient information is never misused. Every procedure and diagnosis must be correctly coded to ensure that proper payment is received and that claims are not denied....
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