CodeBusters: A Quick Guide to Coding and Billing Compliance for Medical Practices
With healthcare costs continuing to skyrocket, despite the efforts of managed care and other containment programs, third-party payers are sc rutinizing every line of every claim for services. When questionable i tems are identified, the next step is usually a request for copies of your patient's medical records, in order to verify that services bille d were actually provided. As a physician, whether in a large group or solo practice, you must understand how the coding and billing process works, and assure that all official guidelines are being followed by y our staff. This book is a quick reference to the basics of coding for physician services, and provides checklists of questions for physician s and office staff. Also included are suggested resources for addition al assistance with coding and billing problems.
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AAPC addition Adequate Documentation AHIMA Appendix appropriate assessment assign auscultation axillae Chapter cheat sheet chief complaint claim form Clean claims code descriptions coding and billing Coding and Reporting complex consult contains copies counseling and coordination critical care critically ill Data Elements date of service denials determine diagnostic testing digits documenta E&M code E&M services encounter established patient EVALUATION AND MANAGEMENT filed follow-up global period HCFA HCPCS Health hematoma History PFSH hospital inpatient managed care medical decision medical necessity medical record medical terminology medically necessary Medicare modifier Official Guidelines outpatient services palpation patient record patients receiving payment physician physician services primary diagnosis problem procedure codes Q exam reimbursement require Review of Systems rule/out services provided signs specific spent staff submit superbill sure surgical procedure symptoms Systems ROS terminology third-party payers TRANSLATING THE RECORD treatment updated vitrectomy