Compliance For Coding Billing Reimbursement 2nd Edition

While the vast majority of providers never intend to commit fraud or file false claims, complex procedures, changing regulations, and evolving technology make it nearly impossible to avoid billing errors. For example, if you play by HIPAA’s rules, a physician is a provider; however, Medicare requires that the same physician must be referred to as a supplier. Even more troubling is the need to alter claims to meet specific requirements that may conflict with national standards. Far from being a benign issue, differing guidelines can lead to false claims with financial and even criminal implications. Compliance for Coding, Billing & Reimbursement, Second Edition: A Systematic Approach to Developing a Comprehensive Program provides an organized way to deal with the complex coding, billing, and reimbursement (CBR) processes that seem to force providers to choose between being paid and being compliant. Fully revised to account for recent changes and evolving terminology, this unique and accessible resource covers statutorily based programs and contract-based relationships, as well as ways to efficiently handle those situations that do not involve formal relationships. Based on 25 years of direct client consultation and drawing on teaching techniques developed in highly successful workshops, Duane Abbey offers a logical approach to CBR compliance. Designed to facilitate efficient reimbursements that don’t run afoul of laws and regulations, this resource – Addresses the seven key elements promulgated by the OIG for any compliance program Discusses numerous types of compliance issues for all type of healthcare providers Offers access to online resources that provide continually updated information Cuts through the morass of terminology and acronyms with a comprehensive glossary Includes a CD-ROM packed with regulations and information In addition to offering salient information illustrated by case studies, Dr, Abbey provides healthcare providers and administrators, as well as consultants and attorneys, with the mindset and attitude required to meet this very real challenge with savvy, humor, and perseverance.

Healthcare providers have to cut through more red tape than ever to get paid for their services. What's more, a mountain of mandates from federal and state government is pressuring providers to be more astute about laws regarding taxes, health and safety, labor issues, antitrust, patient confidentiality and financial compliance.Compliance for Coding, Billing & Reimbursement gives readers the guidelines for the four factors that influence the compliance coding, billing and reimbursement process and how to follow the trends in these areas. The book also analyzes the status of different payment methodologies being used today and advises providers on how to adjust to the transition from a cost-based system to prospective payment and capitation.Compliance for Coding, Billing & Reimbursement also defines the confusing terminology used in the complex web of policies and procedures. By referring to the comprehensive glossary and acronym listing, readers have instant explanations at their fingertips. Topics addressed include: -- How to structure a CBR compliance program -- How to spot CBR problem/opportunity areas -- Investigation and problem solving -- Developing CBR policies and procedures -- Effective training programs and how to implement change -- Monitoring and corrective action -- How to conduct a baseline audit -- Integrating a CBR compliance plan in with a corporate compliance plan -- Appendices containing important internet addresses, synopses of healthcare fraud laws and compliance case studies

For healthcare providers and patients alike, the ways of private third-party payer payment systems can be mysterious and oftentimes quite frustrating. Payment for hospital, nursing, or homecare services can be subject to a variety of payment systems including cost-based and charge-based or those with payments that are determined in advance. Knowing

The fourth book in the Healthcare Payment System series, Cost-Based, Charge-Based, and Contractual Payment Systems compares cost-based systems, charge-based payment approaches, and contractually-based payment processes with fee-schedule payment systems and prospective payment systems. Supplying readers with a clear understanding of important backgr

Medicare fraud is big business, but while only a few profit from intentional malfeasance, the Centers for Medicare and Medicaid Services is now taking a closer look at everyone. The Medicare Recovery Audit Contractor Program, already infamously known as the RAC, swings into full operation in 2010 and every healthcare provider that receives payment

Medical Coding For Non-Coders delivers a valuable introduction to medical coding for those in healthcare who need to understand the process of coding, but do not need the level of specificity required to become a coding professional. In today's ever-growing, complex healthcare system, it is imperative that all healthcare professionals have a basic understanding of the coding process. This book explains how the documentation they supply impacts the coding process, healthcare data, and reimbursement as a whole. New to This Edition Provides information on the transition to ICD-10-CM and ICD-10 -PCS Updated for the most recent coding rules and regulations Updated appendices include the AHIMA code of ethics, and the process for querying physicians Key Features Presents a coding overview in an easy-to-understand format, detailing the impact of coding on reimbursement, compliance, and fraud and abuse. Provides a short overview of the coding systems, including information on the transition to ICD-10-CM and ICD-10-PCS. Provides an overview of the process of coding including what causes delays from patient admission to final billing of the visit. Addresses basic, yet critical questions such as: What does a coder require to provide accurate coded data? How is a medical record converted to coded data? How are codes assigned? How is coded data used?