Emergency Department Coding And Billing

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.

Code faster — and with spot-on accuracy — with the Coders’ Specialty Guide 2024: Emergency Medicine. Are you ready to take on CPT® code changes? Are you looking for help to stop claim denials from siphoning off your revenue? Get the upper hand with fast and exact coding made easy. The ingeniously designed Coders' Specialty Guide 2024: Emergency Medicine makes nailing down the right code simple and convenient. All the information you need to gather for each service or procedure can be found in one place — official code descriptors, ICD-10 cross references, RVUs, NCCI edits, anatomical illustrations, expert coding tips, best-in-class strategies, and reimbursement details for Medicare. Plus, a description of the procedure in easy-to-understand terms, so you can confidently translate your providers’ notes into the correct codes. Zip through your coding challenges and safeguard your revenue with these features: Emergency medicine CPT® and HCPCS Level II procedure and service codes, including 2024 new and updated codes Category I-III codes along with official descriptors to facilitate simple code selection Complex emergency medicine procedures explained in plain English lay terms Emergency medicine coding and billing tips from industry experts to aid in reporting specific CPT® codes Updated Medicare reimbursement information for hospitals and physicians Facility and non-facility RVUs for greater accuracy in payments Crosswalks for modifiers NCCI edits to make accurate bundling decisions Vital indicators for global days, diagnostic tests, and more Emergency medicine terminology with lay definitions Quick-view ICD-10-CM crosswalks to check medical necessity Comprehensive specialty code index with page numbers for faster code look-up Easy navigation through headers with code ranges on each page Detailed anatomical illustrations Master 2024 CPT® and HCPCS Level II code changes, conquer compliance, and safeguard your revenue with the Coders' Specialty Guide 2024: Emergency Medicine. *CPT® is a registered trademark of the American Medical Association.

Emergency Room Coding will prepare you for the real world of coding in the emergency department setting. The text provides the beginning coder with a solid foundation of how to code ER charts. We focus on the diagnoses and procedures seen in the majority of community-based hospitals. The scenarios in this book are based on real life experiences and will provide the coder with situations s/he will most likely encounter in the emergency room coding environment. The study guide contains 32 emergency room records. The case studies are representative of what is commonly treated in most emergency rooms. Each case study contains an ER report and an answer worksheet. The ER record serves as a good teaching tool for new coders because ER records do not require as much clinical background to code as inpatient records. However, some of the injury cases may present a challenge for new coders. Also, unlike most coding textbooks, this study guide contains a complete ER report with a full explanation, not just thumbnail sketches. Therefore, Emergency Room Coding is more realistic than the one-to-two line diagnostic statements encountered in most coding textbooks. Finally, the Answer Key for the case studies contains a rationale for all code assignments, as well as directions for locating the correct diagnostic and procedure codes. A multiple choice final review quiz is included at the end of this study guide as an opportunity for coders to test their coding skill set. Emergency Room Coding is updated annually to reflect the annual coding changes. Who is this book for? Coders needing to develop ER coding skills Students/Beginning coders trying to get their first job Anyone needing to understand ER code assignment Coding supervisors HIM Directors Auditors/Compliance Officers Case Managers What's Inside? 32 Case Studies Dictated ER Reports Answer Key Rationale Instructions on how to locate codes in ICD-9 Coding Book Final Exam Linda Kobayashi, BA, RHIT, CCS, has been a coder and coding manager for almost 20 years. Since 1998, Ms. Kobayashi has owned and operated Codebusters, Inc., a nationwide coding consulting company. Widely regarded as a medical coding and auditing expert, she has conducted workshops on a variety of coding topics, including CCS Exam preparation workshops. Throughout her career the author has remained professionally active, as an AHIMA member as well as a member of her state association, CHIA (California health Information Association). Her formal training includes a teaching credential from California State University Los Angeles, a B.A. degree in English Literature from University of California Los Angeles, an RHIT from AHIMA after completing the RHIT program at East Los Angeles College, and a CCS certificate from AHIMA. Extensive experience as a hands-on coder, auditor and educator, and has given the author the expertise to help coders prepare for the professional coding environment.

Emergency Department Compliance Manual, 2016 Edition provides everything you need to stay in compliance with complex emergency department regulations. The list of questions helps you quickly locate specific guidance on difficult legal areas such as: Complying with COBRA Dealing with psychiatric patients Negotiating consent requirements Obtaining reimbursement for ED services Avoiding employment law problems Emergency Department Compliance Manual also features first-hand advice from staff members at hospitals that have recently navigated a Joint Commission survey and includes frank and detailed information. Organized by topic, it allows you to readily compare the experiences of different hospitals. Because of the Joint Commission's hospital-wide, function-based approach to evaluating compliance, it's been difficult to know specifically what's expected of you in the ED. Emergency Department Compliance Manual includes a concise grid outlining the most recent Joint Commission standards which will help you learn what responsibilities you have for demonstrating compliance. Plus, Emergency Department Compliance Manual includes sample documentation that hospitals across the country have used to show compliance with legal requirements and Joint Commission standards: Age-related competencies Patient assessment policies and procedures Consent forms Advance directives Policies and protocols Roles and responsibilities of ED staff Quality improvement tools Conscious sedation policies and procedures Triage, referral, and discharge policies and procedures And much more!

A basic guide to hospital billing and reimbursement, Understanding Hospital Billing and Coding, 3rd Edition helps you understand, complete, and submit the UB-04 claim form that is used for all Medicare and privately insured patients. It describes how hospitals are reimbursed for patient care and services, showing how the UB-04 claim form reflects the flow of patient data from the time of admission to the time of discharge. Written by coding expert Debra P. Ferenc, this book also ensures that you understand the essentials of ICD-10-CM and develop skills in both inpatient coding and outpatient/ambulatory surgery coding. UB-04 Claim Simulation on the companion Evolve website lets you practice entering information from source documents into the claim form. Over 300 illustrations and graphics bring important concepts to life. Detailed chapter objectives highlight what you are expected to learn. Key terms, acronyms, and abbreviations with definitions are included in each chapter. Concept Review boxes reinforce key concepts. Test Your Knowledge exercises reinforce lessons as you progress through the material. Chapter summaries review key concepts. Practice hospital cases let you apply concepts to real-life scenarios. Updated Claim Forms chapter covers the UB-04 claim form. Updated information covers diagnosis and procedural coding, with guidelines and applications. Updated claim forms and names are used throughout.

Emergency Department Compliance Manual provides everything you need to stay in compliance with complex emergency department regulations, including such topics as legal compliance questions and answers--find the legal answers you need in seconds; Joint Commission survey questions and answers--get inside guidance from colleagues who have been there; hospital accreditation standard analysis--learn about the latest Joint Commission standards as they apply to the emergency department; and reference materials for emergency department compliance. The Manual offers practical tools that will help you and your department comply with emergency department-related laws, regulations, and accreditation standards. Because of the Joint Commission's hospital-wide, function-based approach to evaluating compliance, it's difficult to know specifically what's expected of you in the ED. Emergency Department Compliance Manual includes a concise grid outlining the most recent Joint Commission standards, which will help you understand your compliance responsibilities. Plus, Emergency Department Compliance Manual includes sample documentation and forms that hospitals across the country have used to show compliance with legal requirements and Joint Commission standards. Previous Edition: Emergency Department Compliance Manual, 2018 Edition, ISBN: 9781454889427¿

Emergency Department Compliance Manual, 2017 Edition provides everything you need to stay in compliance with complex emergency department regulations. The list of questions helps you quickly locate specific guidance on difficult legal areas such as: Complying with COBRA Dealing with psychiatric patients Negotiating consent requirements Obtaining reimbursement for ED services Avoiding employment law problems Emergency Department Compliance Manual also features first-hand advice from staff members at hospitals that have recently navigated a Joint Commission survey and includes frank and detailed information. Organized by topic, it allows you to readily compare the experiences of different hospitals. Because of the Joint Commission's hospital-wide, function-based approach to evaluating compliance, it's been difficult to know specifically what's expected of you in the ED. Emergency Department Compliance Manual includes a concise grid outlining the most recent Joint Commission standards which will help you learn what responsibilities you have for demonstrating compliance. Plus, Emergency Department Compliance Manual includes sample documentation that hospitals across the country have used to show compliance with legal requirements and Joint Commission standards: Age-related competencies Patient assessment policies and procedures Consent forms Advance directives Policies and protocols Roles and responsibilities of ED staff Quality improvement tools Conscious sedation policies and procedures Triage, referral, and discharge policies and procedures And much more!