Coding systems include: International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) Health Care Common Procedure Coding System Current Procedural Terminology (CPT) HCPCS Level II codes (national codes)
The claims review process requires Verification of the claim for completeness and accuracy Comparison with third-party payer guidelines (e.g., expected treatment practices) to authorize appropriate payment refer the claim to an investigator for a more thorough review Medical assistant is employed by a provider to perform administrative and clinical tasks that keep the office or clinic running smoothly.
Medical practice consultants Auditors Compliance monitors Instructors for community education programs specializing in training medical billers and coders Textbook writers Newsletter writers Industry publications
B. Understand your contracts 1. When are they renewed? 2. Make notes on parts that are not running as expected 3. Know your provider’s relations agent C. Remain Current 1. Regarding news releases from CMS 2. Changes in industry 3. New technology
Skills needed: Background in word processing Knowledge of computer applications Anatomy and physiology Medical terminology Insurance claims processing Excellent keyboarding skills Basic math skills In this detail-oriented industry Typographical errors can completely change the information provided
Benefits students and facilities that accept students for placement Students receive on-the-job experience prior to graduation, and the internship assists them in obtaining permanent employment. Facilities benefit from the opportunity to participate in and improve the formal education process.
Employer Liability Self-employed – Independent contractors Professional liability insurance Respondeat Superior – “Let the master answer”
Avoid problems: Establish a telephone-availability policy that works for patients and office staff Set up an appropriate number of dedicated telephone lines (e.g., appointment scheduling, insurance, and billing) based on the function and size of the health care setting Inform callers who want to speak with the physician (or another health care provider) that the physician (or provider) is with a patient. Assign 15-minute time periods every 2–3 hours when creating the schedule, so physicians (and other health care providers) can return telephone calls. Physically separate front desk check-in/check-out and receptionist/patient appointment scheduling offices Require office employees to learn professional telephone skills
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