Mo 260 seminar 5

Plus mid term review!

• What is an ICD- 9 code?•  • ICD-9-CM (International Classification of

Diseases, 9th Revision, Clinical Modification) coding system is used to code signs, symptoms, injuries, diseases, and conditions.

• Tells what the problem is. Each sickness, injury etc has a designated code.

• What is a CPT code?• CPT is an acronym for Current Procedural

Terminology.   CPT codes are published by the American Medical Association,  and the fourth edition  is the most current.   The purpose of the coding system is to provide uniform language that accurately describes medical, surgical, and diagnostic services.

• A CPT code is a five digit numeric code that is  used to describe medical, surgical, radiology, laboratory, anesthesiology, and evaluation/management services of physicians, hospitals, and other health care providers.  There are approximately 7,800 CPT codes ranging from 00100 through 99499.  Two digit modifiers may be appended when appropriate to clarify or modify the description of the procedure.

• The critical relationship between an ICD-9 code and a CPT code is that the diagnosis supports the medical necessity  of the procedure.   Since both ICD-9 and CPT are numeric codes, health care consulting firms, the government, and insurers have all designed software that compares the codes for a logical relationship.  For example, a bill for CPT 31256, nasal/sinus endoscopy would not be supported by ICD-9 826.0, closed fracture of a phalanges of the foot.     Such a claim would be quickly identified and rejected.

• http://www.cdc.gov/nchs/icd9.htm

• To have a clean claim, the insurance claim form must contain all of the following:

• Correct diagnostic code • Name and address of the person with the

insurance • Correct procedural code • A signature of the provider

• Procedural codes have five digits and can have modifiers.

• Diagnostic coding should be accomplished using Progress notes , Coding from the Coding listings , encounter form, Old diagnoses that are being evaluated on this visit.

• All office visits will NOT have an illness diagnostic code.

• When coding for a visit or procedure: use progress notes, CPT book, encounter forms and even old diagnosis codes. Use fee schedule for CPT codes.

• Code based on the contract with insurance company

• collections- you won’t get full amount form agency

The Fraud and Abuse Control Program was established by the government under:

HR3103 Subtitle A The first fraud alert was issued in: 1988 Under the Beneficiary Incentive Program,

beneficiaries receive at least which of the following dollar amounts for reporting fraud? $100

• FRAUD: An intentional deception or misrepresentation made by an individual who knows that the false information reported could result in a benefit to himself/herself or another person.

• ABUSE: An incident or practice not consistent with sound medical, business, or fiscal practices, such as providing medically unnecessary care or care that does not meet the standards of care.

Units 1-4 review

• Use good verbal and non verbal skills• Never have a pt wait more than 15 mins

without talking to them.• Buffer times in appt book are 30 mins• Follow up appts 15 mins

• Setting up room: see what the chief complaint is so you know what supplies to have ready.

• Use the tools/supplies your Dr. likes• Dr’s will use same tools as others for

same procedures• Clean room between EVERY pt.• Disinfect and sanitize according to

directions on manufacturers bottles

• Alcohol based rubs great for time saving, and if your hands not badly contaminated.

• Wash hands -- hot water, soap and friction needed. FRICTION is most important factor!

• Keep lids tight on alcohol containers: very flammable.

• New pt’s: always have them sign confidentiality paper, fill out health Hx forms, put forms in charts as soon as you get them, use policy manual when deciding which forms to use.

• CC= chief complaint, reason pt being seen, NOT why they called for an appt.

• Banking-• Acct payable- what you owe• Acct receivable- what you get• Petty cash- for misc stuff– always get a

receipt and carry change back to office in your pocket

• Day sheet– list items for that day like money came in via pt or mail daily charges and adjustments

• Bookkeeping- entries include, NSF checks, collections, refunds etc

• When transferring info from one bookkeeping system to another, it’s called posting.

• Be able to answer all pt questions about billing and when you collect $$ make sure it matches encounter forms

• Know clean claims v dirty claims

• Know how to do payroll:• 6.2 % comes out for SS. ½ from employee, ½

from employer• Know deductions, marital status, length of

pay period. NOT how many children one has• Be able to retrieve financial records easily,

keep them stored in logical order. Never throw out without Dr. permission

• PPE--- know what a PPE is, when you need them, when you don’t; labs urine v EKG etc.

• OSHA standards– office, universal precautions, NOT the environment; like global warming etc.

• http://www.youtube.com/watch?v=S2X35vD-gyo

• http://www.youtube.com/watch?v=_aKZbiO3Z4U