Medical coding - ☑☑process of translating a healthcare provider's documentation of a patient encounter into a series of numeric or alphanumeric codes
Health information coders, medical record coders, coder/abstractors
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Medical coding - ☑☑process of translating a healthcare provider's documentation of a patient encounter into a series of numeric or alphanumeric codes
Health information coders, medical record coders, coder/abstractors, coding specialists - ☑☑coders who specialize in coding inpatient hospital services
MS-DRG - ☑☑Medical Severity-Diagnosis Related Groups
MS-DRG are used to: - ☑☑determine the amount the hospital will be reimbursed if the patient is covered by Medicare or other insurance programs using the MS-DRG system
Cancer (or tumor) registrars - ☑☑maintain facility, regional, and national databases of cancer patients
EHR - ☑☑electronic health record
Other roles coders can have: - ☑☑consultants, educators, medical auditors
Outpatient coders - ☑☑use CPT, HCPCS Level II, and ICD-10-CM codes; work in provider offices, outpatient clinics, and facility outpatient departments; also use Ambulatory Payment Classifications (APCs); have more interaction with providers
Inpatient coders - ☑☑use ICD-10-CM and ICD-10-PCS codes; also use MS-DRGs for reimbursement; have less interation directly with providers
Remittance advice (RA) / Explanation of Benefits (EOB) - ☑☑explains the payer's determination in payment
Scope of practice - ☑☑practice guidelines for each level of a provider individually dictated by states
Mid-level Provider (MLP) - ☑☑include physician assistants (PA) and nurse practitioners (NP); aka physician extenders
Physician Assistant (PA) - ☑☑Works under the supervision of physicians; PA program takes approximately 26 1/2 months to complete after completion of a bachelor's degree
Nurse Practitioner (NP) - ☑☑have a master's degree in nursing
Two types of payers: - ☑☑private insurance plans and government insurance plans
Medicare - ☑☑primary government payer in the U.S.; provides coverage for people 65 and older, blind, disabled, and people with permanent kidney failure or end-stage renal disease (ESRD)
Medicare Part A - ☑☑Inpatient coverage, home health, hospice, skilled nursing facilities; also defines limits of Medicare usage
Medicare Part B - ☑☑The part of the Medicare program that pays medically necessary provider services, preventative services, durable medical equipment, and other services and supplies.
Medicare Part C (Medicare Advantage Plans) - ☑☑combines benefits of Part A, B, and sometimes D; managed by private insurers approved by Medicare; may charge different copays, coinsurance, or deductibles
CMS-HCC - ☑☑Centers for Medicare & Medicaid Services-Hierarchical Condition Category
Medicare Part D - ☑☑Prescription drug coverage
Medicaid - ☑☑health insurance assistance program sponsored by federal and state governments for low-income people
Limiting charge - ☑☑set limits on what the patient can be charged
SOAP - ☑☑subjective, objective, assessment, plan
Subjective - ☑☑patient's statement about his or her health, includes symptoms
Objective - ☑☑provider's examination and documentation of the patient's illness
Assessment - ☑☑evaluation and conclusion made by the provider; where you find the diagnoses
Plan - ☑☑course of action
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