Reimbursement Methodologies

Reimbursement Methodologies

Discussion

Week 3

Part 1: Discuss the difficulties that can occur if communication with patients isn’t clear.

Today I will discuss the difficulties that occur if communication with patients is not clear. Doctor patient communication is very important. If your communication with your patients isn't clear then it can cause serious health problems or even death. Sometimes patients don't understand what the doctor is saying. Sometimes when Doctors and nurses are talking to patients they are using big words that patients don't understand. They forget sometimes that the patients didn't go to medical school. Some patients just agree instead of asking for clarification. If you are unsure the patient has clarification

Page 11-52 is the rest of the section. Page 52 gives a spot for you to write notes if you need to. E/M codes start with 99201 and go to 99499. These are encounters such as office and hospital visits. This is an evaluation of the patient care by a physician. In this category, there are six different sections

This section is a part of the billing process, it tells the insurance what needs to be reimbursed. There are seven components. History, Examination, Medical Decision Making, Counseling, Coordination of Care, Nature of Presenting Problems, and Time. E/M coding has become the most frequently billed physician service, and auditors are taking notice of its popularity. Frequent E/M coding errors happens when therapeutic practices are either upcoding or undercoding. Upcoding builds the danger of reviews. Coding too minimalistically doesn't shield your training from reviews, and it seriously diminishes your level of repayment. Here are some common pitfalls: Not following guidelines: When you don't follow the guidelines it can cause your coding to be incorrect. Mismatching the diagnosis with the procedure: You have to make sure the linking are correct. Billing for a consultation or a referral: You have to make sure you are billing for the correct thing if it a consultation then makes sure that is what you are billing. When you code the place of service make sure you are coding the correct place of service, you can not code public health clinic if the place of service was at the prison/correctional facility. When coding and you have a modifier, make sure that you are using on when needed and make sure the one you are using goes with the code. If you leave a modifier off or use the wrong modifier then it changes