The task of the coder is to code to the greatest degree of precision. This involves abstracting the most knowledge and taking detailed notes from the provider’s medical records. For both treatments and diagnosis, it also requires understanding the medical terms. Coding or undercoding to a general level can lead to a claim that is refused or denied. Not coding to the highest degree, of course, is not necessarily the responsibility of the coder. In certain instances, the supplier may not give adequate information about the process they have conducted to the coder. Providers may leave out of the report substantial details of the operation, or may have illegible medical records. The next trouble spot on the list exacerbates this problem (“Common Problems in Medical Coding”, 2020).
Every coder will preferably be in regular communication with the provider for whom they are coding. That, sadly, isn’t always the case. On difficult-to-understand statements, suppliers are not always willing to consult. Coders have to do their best in these cases with what they have, but you can also try to explain the report as best as you can. Failing to capture patient’s information from the start leads to claims concerning reimbursement delays. This because there is missing information about the patient that should be included and the billers may take a long time to get this information (“Common Problems in Medical Coding”, 2020).
A national provider identification number for nurse practitioners is a ten-digit number that provides a detailed information including personal overview history of education and training. It also provides information of where the nurse practitioners are located.
3 minutes ago, at 4:34 PM
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- Prepare examples of various coding and billing issues that you have experienced in the clinical setting (Peds and women’s health).
There are various common issues in coding and billing within the Peds and women’s health clinical setting. For example, sometimes the necessary information is not given to the payers to back up claim hence that leads to delays or denials. This may be as a result of the billing department workforce not linking diagnosis code to the Healthcare Common Procedure Coding System code or Current Procedural terminology (McManus et al., 2020).Sometimes, there are upcoding cases where the billing of patients show more complicated procedures compared to the actual services or bills that are presented for services which were never conducted. Still, there are cases where information about the patient is incorrect or missing due to omissions before submission. That leads to wrong patient records being presented and mismatches being received by the insurer and the claim is denied (HRSA ,n.d.). There is a time when telemedicine coding errors occur in a way that incorrect modifiers for telehealth services are used hence payments delay. Then finally, there are issues of incorrect procedure codes where there could be entrance of incorrect procedure codes for patients or incorrect documentation of information on the encounter forms or supporting documents where the employee is unaware of the latest coding rules. That could also lead to denial or delay in reimbursements.
- Provide a brief description of the NPI numbers for nurse practitioners.
These numbers are unique for each physician in varied states within the diverse medical groups. It contains the personal overview, history of education, specialties, practice location, and training among many other aspects(Apha,2008+). The provision of this number is based on the NPPES Date dissemination notice.
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5 minutes ago, at 4:32 PM
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Inadequate data where payers lack adequate information to boost their claims which leads to delays or denials. For example, issues can happen if the billing department staff do not connect diagnosis code to the current procedural terminology. Though these errors are associated with the staff, if physicians do not offer appropriate diagnosis information, they are prone to happen. There is upcoding which happens when patients get billed for more complex procedures than the real bills submitted for the services never rendered. The example is when the billing department staff make errors when entering treatment codes or get confused by the physician information.
There are the telemedicine coding issuers where the technology in the healthcare makes things easier but they also make the billing process complex. Such examples are the inappropriate utilization of modifiers for the telehealth services outcomes in payment delays. Missing information issues like omitted patients’ names, birth dates, sex, insurance information, and dates of treatment. (Bajowala, Milosch, & Bansal, 2020). If the staff just key in information without verifying, such issues are prone to happen. Inappropriate procedure codes. If the hospital experiences regular claims on incorrect procedure codes, the staff may be missing out on the latest coding regulations.
All healthcare providers or firms under the HIPAA from nurse practitioners to physicians must have the NP1. The nurse practitioners are able to apply for the NPI by visiting the national plan and provider enumeration system; NPPES website and generate a login. (Vu, 2018). An individual’s licensing information will be required. This means that the personnel should have their state APRN and RN license at hand. This is a free and easy process.
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9 minutes ago, at 4:28 PM
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With the complexities that tend to be linked to the system of medical coding, mistakes are bound to occur. Unfortunately, even the errors that are minor results in delays in payments and denials of claim. These mistakes affect the physicians relationship with their patients. These issues include: data that is not adequate meaning, when information is not offered to payers supporting the claims, it leads to delays or denials. For example, challenges are capable of occurring in case department of billing ends up not linking a code of diagnosis to the healthcare common procedure coding system. Despite the fact that the error of employees leads to the issues, physicians might cause it in case they provide diagnosis information that is inaccurate. (Cantu, 2019)
Another issue is upcoming which takes place if a patient gets billed for procedures that are more complex as compared to what they got or submission of bills that patients never got the services. Procedure codes that are not correct whereby it might happen through an entry that is not correct regarding the procedure code. There is also the probability of the information been documented incorrectly on the encounter forms as well as additional supporting documentation
An NPI basically is referred to as an identifier of digit numerical for the health care services providers. It considered to be national within its scope in addition to be unique to a particular provider. However, previously, a provider was known for having an identification number that is different for every payer (Edge, 2019).
There are various billing and coding errors in medical practice. Just like my colleague, I have encountered various complaints regarding the issues of medical billing and coding errors in my pediatric and women practice. The most common problem in medical coding and billing is bad documentation or missing documentation, an aspect that translates to a lack of enough data, as asserted by my colleague. As such, I am of the same view that if the provider fails to provide enough information, like not linking the diagnosis to the right CPT code, then the payer may deny the transaction or create a delay. Again, failure to use the current or updated code sets as well as failure to code the highest level serves as the other most common avenues of medical billing and coding issues. They are the root cause of incorrect or missing medical information, telemedicine coding errors, and incorrect procedure codes. However, service providers can adopt strategies like being diligent, communicating often, and staying sharp in an attempt to avert the common problems in medical and billing aspects. It is the sole responsibility of the provider to embrace strategies that see the prevention of errors (Grant-Kels et al., 2016).
I admit that a National Provider Identifier (NPI) is an exceptional 10-digit number given to healthcare providers by Medicaid and Medicare services. In other words, NPI is a unique identification number issued to health care providers that are covered by Medicare and Medicaid. Furthermore, having been established around 1996 under HIPAA financial and administrative regulations, NPI become popular in 2006 (MB&CC, n.d). Again I agree that NPI is essential since it allows the provider to identify themselves in transactions or medical correspondence. The provider will carry this unique code throughout their career to any practice that they join. Finally, to obtain one, the provider must apply under the NPPES website. However, the author ought to have given a brief description of the NPI application process.
Maritza Leon Cosme
12/3/20, 2:22 PM
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Having worked as a clinical practitioner, one must face various issues regarding coding and billing. There is still inadequate data to back up treatment which leads to different opinions by both the provide and the payer regarding payment, resulting in a possible delay to payment. Additionally, there are cases when the coder is provided with inadequate information that has been documented. The provider may fail to provide all the information regarding the procedure they have performed. This results in wrong information or missing information which is illegible for use in the scenario. This results in another problem of uncoding if the patient has been billed for the wrong services. The implemented procedures can also because of telemedicine coding errors, which gives wrong information, or it has omitted certain errors that leave out important information. At times billing and coding issues might arise due to the failure by the coder to use the current system of coding. Most of the organizations update their billing codes annually, therefore coders must update their skills regularly to ensure they always have the appropriate codes. Despite these challenges, the errors can be avoided by always using updated coding systems as well as ensuring the information is accurate (Rumpakis, 2018).
National Provider Identifier Number (NPI) is a 10-digit numeric number that is used to identify providers or healthcare entity or a healthcare entity. The number is shared among various stakeholders such as employers, health plans, and covered providers. The NPI is provided by the CMS with the aim of improving electronic transactions through establishment of a standard for electronic healthcare transactions. This aimed at the reduction of administrative burden on healthcare providers (Reed, 2020). This number is used by the providers to identify themselves in any care setting they go and is not confidential as one might thing.
EDUARDO SOTO QUINONES
12/3/20, 9:15 AM
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Most nurse practitioners in a clinical setting may have different coding requirements adding another layer of complexity to the coding and billing process. There are some errors which may occur in the process of coding and billing which may greatly affect the coding and billing process. In addition these types of errors can also affect the relationship of the nurse practitioners and the patients.
Telemedicine Coding Errors is one of medical coding issues, it occurs when most healthcare technology provides quality care to their patients in multiple locations much easier but at the same time it complicates the billing process. For instance the GT modifier applies to real time telehealth services provided by video or audio systems but on the other hand the GQ modifier deals with services provided through asynchronous telecommunications systems, such as an emailed X-ray (Santos, et al., 2008). The use of manual claim management process is another medical and coding errors that impact health care practitioners. Providing claims is not an easy task. It requires the use of efficient communication channels between the clinician and the client. Manual claims management processes tend to be susceptible to inaccuracies. Other examples of the coding and billing issues in healthcare include insufficient data; some nurses may fail to provide enough information to payers to support claims thus resulting in delays; and if a physician fails to provide accurate diagnosis information.
NPI can be defined as a special identification number for covered health care providers. It was developed in order to enhance the efficiency and effectiveness of electronic transmission of health information (ASHA, 2020). All nurse practitioners are eligible to NPIs. These numbers are of important to nurse practitioners since they help them to settle claims. In addition, NPI aid in eliminating the need for the care givers to use differing identification numbers when carrying out business with various health plans.
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Yindra Isaac Amador
12/2/20, 10:41 PM
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Medical billing mistakes can lead to many problems, such as claim denials, delayed payments, customer complaints and lost productivity. I have seen my share of medical billing errors and have learned from them so that I don’t make these mistakes in the future. A common coding error is failure to verify insurance, this might cause the clinic to provide services to an individual who is not covered by insurance on the date of service. The resulting claim denial represents both a potential loss of revenue (if the individual cannot pay, then the clinic faces a bad debt write-off) (Park, Hyun & Yoon, 2017).
The best solutions to addressing medical billing mistakes include training the staff well. My clinic, for example, works with a third-party medical billing company that knows exactly what they are doing. If the facility is not comfortable with outsourcing, then it should put an action well-documented processes and protocols for medical billing, and increasing internal audits to determine where a LHD is succeeding and failing with respect to medical billing mistakes (Phillipsen, Setlow & Jacob, 2018).