Html oachs p and a watters 2016 health information

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html Oachs, P. and A. Watters. 2016. Health Information Management: Concepts, Principles, and Practice , 5th ed. Chicago: AHIMA.
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184 Copyright ©2017 by the American Health Information Management Association. All rights reserved. 4.2 Compliance and case mix Subdomain IV.A.4 Implement processes for revenue cycle management and reporting Subdomain V.A.2 Determine processes for compliance with current laws and standards related to health information initiatives and revenue cycle Determine the aspects of a compliance plan that need to be addressed following the identification of coding errors such as those that were found in exercise 4.0, and explain why they must be tackled. Answer Compliance plan elements that should be addressed include: Education and training: Staff need to know and apply coding guidelines Auditing and monitoring: Continued monitoring should be in place to ensure correct code assignments made after education provided Corrective action: Follow the payer guidelines for resubmission and correction of claims (Casto and Forrestal 2015, 444) References Casto, A. B. and E. Forrestal. 2015. Principles of Healthcare Reimbursement, 5th ed. Chicago: AHIMA.
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Copyright ©2017 by the American Health Information Management Association. All rights reserved. 185 4.3 Inpatient-only procedure denials Subdomain IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement Subdomain III.H.4 Perform quality assessment, including quality management, data quality, and identification of best practices for health information systems Subdomain IV.A.1 Manage the use of clinical data required by various payment and reimbursement systems Your organization just opened a new service line: outpatient spinal fusions. The first cervical spinal fusions were done last week, and your coders have coded 10 of them. Unfortunately, several weeks and another 25 procedures later, you get a memo from the business office stating that there are denials on the Medicare fusions (17 to date). The billing manager states that it is something about a status indicator “C.” She would like you to review the CPT code assignments and help determine what the problem is and how it can be resolved because the charges for these procedures exceed $35,000 per case. After reviewing the cases, the CPT codes assigned are correct. 22551–arthrodesis cervical *22845–anterior instrumentation 22851-use of biomechanical device (cage) *20936-autograft of bone from same site *denotes a status indicator of C for that CPT code 1. Explain to the billing manager what status indicator C means. Answer Status indicator C represents an inpatient-only procedure under Medicare, meaning the organization will not receive payment for the encounter if it was done as an outpatient. (Hazelwood and Venable 2016, 228–229) 2.
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