Hcs/533 - Definition of Terms Essay

The ninth edition of the ICD codes were developed and pushed in a direction so that the codes could be used for billing instead of just disease classification. (Department Health and Human Services, 1998)

The electronic health record (EHR) is a digital record of a patient’s health history that may be made up of records from many locations and/or sources, such as hospitals, providers, clinics, and public health agencies. The EHR is available 24 hours a day, 7 days a week and has built-in safeguards to assure patient health information confidentiality and security. (Huston, 2013)

Electronic health records (EHR) are health records that are generated by health care professionals when a patient is seen at a medical facility such as a hospital, mental health clinic, or pharmacy. The EHR contains the same information as paper based medical records like demographics, medical complaints and prescriptions. There are so many more benefits to the EHR than paper based medical records. Accuracy of diagnosis, quality and convenience of patient care, and patient participation are a few examples of the

After decades of paper based medical records, a new type of record keeping has surfaced - the Electronic Health Record (EHR). EHR is an electronic or digital format concept of an individual’s past and present medical history. It is the principle storage place for data and information about the health care services provided to an individual patient. It is maintained by a provider over time and capable of being shared across different healthcare settings by network-connected information systems. Such records may include key administrative and clinical data relevant to that persons care under a particular provider. Examples of such records may include: demographics, physician notes, problems or injuries, medications and allergies, vital

The first edition helped reassure the use of customary terms and clarifications to record procedures in the medical documents; delivered the foundation for a computer based system to assess and evaluate operational procedures; facilitated effective communication as precisely as possible for the data related to procedures and services to organizations connected with insurance claims and conveyed uncomplicated data for analyzation and statistical commitments. This first edition focused on procedures for surgeries and touched on some degree of laboratory, radiology, and prescription techniques. These restrictions encouraged the delivery of the second edition of CPT just four years later in 1970. With this subsequent publication there was a heightened

HIPAA requires two designate coding system to be used to report to private and public payers; this is HCPCS and ICD-10. This coding system is primarily used in the United States and it is used by healthcare providers, including physicians and hospitals. Icd-10 is useful for reporting inpatient and HCPCS is used for procedure reporting for outpatient service and they are both assigned to DRG group. Once the health service is performed, charge captures are slips that are posted to a patient’s account that is processed as a batch order system. The key to the ordering system and charge capture is the “charge code” which is then reflected each service, procedure, supply item or drugs in the chargemaster (CDM). Medical claims fall into one of two types: CMS

One of the greatest milestones in the United States health system is the use of electronic health records codes to ensure consistency in diagnosis and treatment procedures provided by physicians (Romano & Stafford 2011). The purpose of the case scenario of the sixteen year old female who visits the emergency department is to show how electronic health record coding is done and its impact on health reimbursement. The International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) codes are brought out well in the case study showing how they help in ensuring physician consistency in coding diagnosis and treatment procedures for the purpose of health reimbursement.

ICD -9 and ICD-10 are the diagnoses codes. The health insurance needs the diagnoses codes in order to authorize the procedure. The CPT codes are used to explain which procedures the patient received from their physicians. These are usually used for outpatient procedures. If the attending physician or referring physician changes procedures at the time of service, that CPT code also has to be changed and verified ASAP. Authorizations from the insurance company may need to be obtained before that service is done. If these codes are not correct, when the claim is filed for reimbursement, the insurance company may deny the coverage. The patient may be responsible for the entire expense of their service. More often than not, the facility ends up with the burden the costs. There are many times the patient has her procedure done before the required authorization was obtained. Some insurances would retro date the authorization, some would not. There are many times I would have to work on the patient’s account, verify the insurance as well as secure the authorizations, if needed. This is all happening as the patient is waiting at the registration desk, waiting for the ‘go ahead’. Sadly, there are those patients given contrast for their radiology procedure, just to say they have to reschedule their appointment because authorizations weren’t obtained in time. I have to say this infuriates me because this does not need to

The definition of ICD-10 diagnosis codes are a tool that groups and identifies diseases, disorders, symptoms poisonings, adverse effects of drugs and chemicals, injuries, and many other reasons for

Corresponding with other facilities as to what kind of reimbursements they are receiving, and which ones provide the highest revenue, would be quite beneficial to a provider. One thing that a provider must also take into account, is the fact that if a proper diagnosis is not tied into a procedure, payment may be lowered or not made at all. That is why hiring an experienced billing clerk is crucial to a facility (Healthcare Management, (2002), IPA clinic coordination by: Ingrid

DRG determines the payment under Medicare Part A program for acute short-term inpatient hospital services. DRG systems have changed over the years, it is still used for prospective payment for the Medicare program for inpatient hospital services. Also, many states now use various forms for Medicaid programs and commercial insurers. The DRG payment is determined by a combination of key data elements, the hospitals location where the services are performed and demographics. The hospital stay is determined by the patients diagnoses, ICD-10-CM codes, any surgical procedures performed and the age of the patient and discharge status. DRG groupings refers to DRG codes, patient classification model and key elements determines the number of codes. The classifications are labeled using groupings referred to as DRG code and the number of codes

By definition, a MS-DRG is “a system of classifying a Medicare patient’s hospital stay into various groups in order to facilitate payment of services.1” The DRG system was created through Yale University’s Schools of Management and Public Health1. The system organizes potential human disease diagnoses into more than 20 body systems1, and then further organizes the body systems into over 450 subgroups. This organization helps to “classify the care that hospitals provide.1” The way this system works specifies which body system and groups are affected with the amount of hospital resources required to treat each condition. The ending result is a fixed rate for patient services, call

Due to the advances in technology, medical practitioners are more able to retrieve medical information. Coding systems, such as ICD-10-CM, CPT, and HCPCS are used to code and enter such information into a database. These coding systems are useful in administrative and statistical purposes. The Center for Medicare & Medicaid Services, CMS uses a prospective payment services, which was effected in 2012 and 2013 to ensure better health care at lower costs (CMS, 2015).

Electronic health records (EHRs): Medical records are now kept in an electronic versus a paper chart. All health information regarding past and current medical history, treatment plans, and medications are kept in the EHR. The system also allows sharing of medical information from provider to provider as needed. Many HER systems have a feature to allow patients to log into a patient portal to review lab results, diagnostic tests, plans of care, and email access to the provider

1. All medications scheduled on hospital MAR, 2. All if needed (PRN) medications on MAR, 3. All continuous intravenous fluids infusing into patient’s IV access on MAR