coding Flashcards
ICD codes
diagnostic codes
CPT codes
procedural codes
What are some examples of 3rd party payers?
HMO, PPO, POS, Gov. plans (Tricare, medicare, medicaid), HDHP, HSA
Statutory law
legislation passed by either state legislature or the congress of the US
Who has control over statutory law?
citizens who vote have some control over it
CoPs
Conditions of participation
CfCs
Conditions for coverage
What were Health and Safety standards, CoPs, and CfCs primarily made for?
Patient safety
Examples of CoPs
-Transplant centers
-Psychiatric Hospitals
-Intermediate Care
-Hospitals
-Hospice
-Home Health
Examples of CfCs
-ASCs
-ESRD facilites
-Long term care facilities
-OT practices
-Organ procurement organizations
-Portable x-ray providers
What was mandated by federal or state law?
Retention of Records
Why was HIPAA passed?
Concerns about fraud
COBRA
Consolidated Omnibus Budget Reconciliation Act
How many years was Dr. Barry Schultz sentenced to?
157 years
For one of Dr.Schultz patients, how many oxycodone pills did he prescribe in 7 months?
nearly 17,000; another received 23,000 over an 8 month period
How much was Dr.Schultz a day for prescribing and selling opioids?
$6,000 a day
How bad was the Opioid Crisis in Broward County?
One street had 31 different pain clinics
How much did Dr. Moss bill the US government for and how?
$2.5 million dollars by falsifying Medicare and Medicaid claims either by billing for services he actually did not perform or by utilizing his PA (Mr.Tywon)
NPI#
National Provider Identifier
Who uses CPT codes?
All healthcare providers, payers, and facilities use CPT codes
What do CPT codes help determine?
used by insurers to help determine the amount of
reimbursement
How often are CPT codes updated?
Annually
What are the essential elements in reporting CPT codes?
-Medical Terminology
-Anatomy
-Insurance payer rules
-Procedural bundling rules
-Proper modifier usage
CPT Modifiers
Clarify services and procedures performed by providers
