Clinical_Coding_and_Reiumbursement_Connection

Clinical_Coding_and_Reiumbursement_Connection -...

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Clinical Coding –  Reimbursement Connection
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Clinical Coding-Reimbursement  Connection Reimbursement Payment to healthcare providers and facilities for services delivered to patients Communication of services is transmitted from providers to third party payers via coded information Allows for consistent communication Allows for efficient payment process
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Clinical Coding-Reimbursement  Connection (cont’d) Code sets used to transmit health services are standardized via the Health Insurance Portability and Accountability Act of 1996 (HIPAA) ICD-9-CM HCPCS Coding System CPT HCPCS Level II
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Clinical Coding-Reimbursement  Connection (cont’d) Must have baseline understanding of code sets to fully understand the various Medicare prospective payment systems (PPS) Physicians and facilities must comply with guidelines and conventions published for the approved code sets To receive accurate reimbursement To comply with Medicare Conditions of Participation
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ICD International Classification of Diseases Maintained by the World Health Organization (WHO) Used throughout the world for mortality reporting Updated approximately every 10 years
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ICD-10 Current international version is ICD-10 Used by CDC for mortality reporting ICD-10-CM will be implemented in the United States on October, 2013 This will be another one of those “milestone” events in health care history
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ICD-9-CM International Classification of Diseases, 9 th Revision, Clinical Modification Diagnoses in all healthcare settings Procedures for inpatient encounters Modifications made by the National Center for Health Statistics (NCHS) Expanded to include morbidity and procedures
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ICD-9-CM (cont’d) Uses Classify morbidity and mortality information for statistical purposes Classify diagnosis and procedure information for research Indexing of hospital records by disease and surgical procedure Report information to various healthcare reimbursement systems Analyze resource consumption patterns Analyze adequacy of reimbursement
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ICD-9-CM (cont’d) Used in various Medicare PPSs Hospital inpatient: MS-Diagnosis Related Groups Hospital rehabilitation: Case Mix Groups Long-term care: Long-term Care Diagnosis Related Groups Home health: Home Health Resource Groups
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ICD-9-CM Structure Volume One Tabular List of Diseases and Injuries Classification of Diseases and Injuries Supplementary Classifications Appendices   Volume Two Alphabetic Index to Diseases Index to Diseases and Injuries Table of Drugs and Chemicals Alphabetic Index to External Causes of Injury and Poisoning
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ICD-9-CM Structure (cont’d) Volume Three Classification for Procedures Alphabetic Index to Procedures Tabular List for Procedures Code Structure Diagnosis 3 5 digits Xxx Xxx.x Xxx.xx Procedure 2 4 digits Xx Xx.x Xx.xx
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This note was uploaded on 05/09/2011 for the course HCA 580 taught by Professor Hazelwood during the Spring '11 term at University of Louisiana at Lafayette.

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Clinical_Coding_and_Reiumbursement_Connection -...

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