ACEP Basics of Reimbursement

ACEP Basics of Reimbursement - 1 The Fundamentals of...

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Unformatted text preview: 1 The Fundamentals of Reimbursement: What Every Graduating Resident Should Know Before Starting Practice ACEP Reimbursement Committee As a recent residency graduate, you should have a thorough understanding of the basics of two important reimbursement issues: coding and billing. Both are vitally important because if you don’t code your services properly, you will not be able to bill properly. That means you may not be reimbursed properly for the services you provide, and worse, improper coding could result in accusations of fraud. There is so much clinical information to be learned during a physician’s training period that usually little or no attention is given to practice management issues. Unfortunately, providing excellent care will not correlate with receiving appropriate reimbursement if you do not code and bill correctly. Understanding important issues such as documentation, coding, and billing will add value to your practice. This in turn will make you a more valued employee/partner in an increasingly competitive market place. The following material is intended to introduce emergency medicine residency graduates to the fundamental concepts of reimbursement. Topics covered include a description of the coding system currently in place for physician services, an explanation of the use of the Resource Based Relative Value Scale, and a discussion of compliance issues for avoiding charges of fraud and abuse. Understanding CPT Physician services are reported using a coding system called Current Procedural Terminology – known as CPT – that was developed in 1966 by the American Medical Association. CPT descriptive terms and identifying codes serve several functions in the field of medical nomenclature, including the reporting of physician services and claims processing. CPT’s uniform language is also used for local, regional, and national utilization comparisons. Other countries have been adopting CPT and the AMA has said that it would like CPT to become the dominant coding methodology in the world over the next decade. The AMA publishes a new CPT book each year with input from specialty societies such as ACEP. The 2006 book includes more than 8000 CPT codes and instructions for their use. Changes to the codes and their descriptions are made through the CPT Editorial Panel. The panel is composed of physicians from the various specialties and representatives of government and third party payers. The AMA Department of Coding and Nomenclature also help. ACEP and other specialty societies, appoint advisors to provide input to the panel on issues of interest to their particular specialty. 2 If a specialty society wants to submit an application for a new or revised code, it must complete the appropriate form and submit it to the AMA prior to the deadline for the next CPT Editorial Panel meeting....
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This note was uploaded on 01/11/2012 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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ACEP Basics of Reimbursement - 1 The Fundamentals of...

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