Billing Flashcards
What does CMN administer?
Medicare
Medicaid
CHIP
Health Insurance Market Place
Managed Care Organizations (MCOs)
Designed to provide comprehensive health services while controlling costs
Typically more rigid in covered benefits and provider networks to control costs
Reimbursement system components
Coding
Coverage
Payment
Healthcare Common Procedure Coding System )HCPCS
Level 1- clinician procedural codes
Level 2-DME, prosthetic and orthotics, medical supplies, ambulance
Documentation to support selective debridement should include
Clear description of instruments used for debridement (i.e. high-pressure waterjet, scissors, scalpel, forceps).
Thorough objective assessment of the wound including drainage, color, texture, temperature, vascularity, condition of surrounding tissue, and size of the area to be targeted for debridement
Certification / re-certification may be signed by:
Physicians and NPs
Optometrists may certify only low vision services
Podiatrists consistent with the scope of professional services as authorized by applicable state law
Who can not refer patients for therapy services nor certify therapy plans of care?
Chiropractors and Dentists
When should certification be signed?
within 30 days of evaluation, or with reasonable attempts made
When does re-certification need to occur?
at most 90 days after the initial treatment or if POC significantly changes
Wound Assessment
Include location and age of wound
Wound etiology
Wound dimensions- length, width, depth, undermining, tunneling
Wound stage or depth of tissue involvement
Drainage
Wound base (viable/non/viable
Surrounding skin- redness, temperature, quality
Wound edges
Wound photography
Short term goals- time frame-traditionally 30 days ( in conjunction with progress notes)
Objective
Related to function
Measurable
Specific
Long term goals- time frame typically in conjunction with estimated time of discharge or length of POC.
Specify expected outcomes
Outcomes must be measurable, specific, and functional outcome
