vocab
refers to the conformity toestablished coding guidelines and regulations
what is Coding Compliance
what is step 2
what is Highlight the diagnoses, symptoms, or health status that supports, justifies, and proves the medical necessity of any procedure or service performed.
what does the MCD do
what is helps determine if a procedure or service is reasonable and necessary for diagnosing or treating an illness or injury.
what are there goals
Ensure accurate hospital coding and reimbursement for inpatient claims.
reviewing patient records and CMS-1500 or UB-04 claims to assess coding accuracy and completeness of documentation.
what is auditing process
Improper payments
what is payments that should not have been madeor included an incorrect amount.
what is step 5
Identify the first-listed condition.
step 2 in is practice management steps
what is Implementation of an auditing process
what is step 1
Identify the reason for the claims denial.
what is coding audits
identies incorrect code and DRG assignment that result in overpayments to hospitals
means that eventhough a diagnosis may not receivedirect treatment during an encounter,the provider has to consider thatdiagnosis when determining treatmentfor other conditions
Medically managed
what is step 1
what is Read the entire case scenario to obtain an overview of the documented diagnoses and procedures or services performed. Research any word or abbreviation not understood
fill in the blank Medical practices should also review encounter forms to ensure the accuracy of ________ ____and _________
ICD-10-CM, CPT
what is step 5
Follow up to ensure appropriate reimbursement.
review inpatient hospital claims for patient readmissions within a specified number of days
what is readmission audits
is a waiver required by Medicare for all procedures and services that are not covered by the Medicare program.
what is Beneficiary notice of noncoverage
what is step 3
what is Assign codes to documented diagnoses, signs, symptoms, health status, procedures, and services.
step 3 in practice management steps
Review of local coverage determinations (LCDs) and national coverage determinations (NCDs)
what is step 2
what is Develop effective claims denial management policies.
what is transfer audits
what is review inpatient hospital claims to determine whether transfer or discharge was appropriate
statement of the physician’s future plans for the work-up and medical management of the case.
what is plan
what is step 6
what is Link each CPT and HCPCS Level II to the ICD-10-CM code(s) that justify medical necessity
what is MCE
what is software that detects and reports errors in ICD-10-CM/PCS coded data
Prepare a letter of appeal to obtain appropriate reimbursement.
what is step 4
review short inpatient lengths of stay to determine whether the level of care was appropriate
what is level of care audits