Professional Documents
Culture Documents
If in doubt, query the physician, remembering if not documented, not done. Without sufficient documentation, you cannot code, because documentation is the basis of all coding.
Whos Responsible?
The AAPCs code of ethics includes this statement, Know and respect existing federal, state and local laws, regulations, certifications and licensing requirements applicable to professional work. Wow. Know the regulations?! Most everyone agrees that coding and billing for the services you provide is now more challenging than ever. And most everyone agrees that they dont see things getting simpler; rather they believe things will become even more complex. So, is it really our job as coders to stay current on the ever-changing coding rules and regulations of payers? If it is, that makes it hard to keep up on proper coding to ensure full reimbursement and compliance. Is this where, Thats not my job! comes in? Knowing all of the regulations that govern health care these days can seem overwhelming. Doesnt it seem sometimes that somebody somewhere is overseeing almost everything we do? Many coding and billing professionals feel that they spend more time complying with rules that direct their work than actually doing the work itself. Does that sound like you?? Nevertheless, like it or not, as a healthcare professional, you have the responsibility (and duty as a coder) to keep up with the latest medical coding updates, rules and regulations. After all, coders are responsible for the codes submitted for billing, correct or
incorrect. And nobody wants to be accused, or even associated with, the f word Fraud! (However, it is possible for coders to be charged with fraud. Yikes!) A statement on the OIG Website, in a March 2013 AARP article, said , Fraud and waste are the Bonnie and Clyde of American health care, robbing the system of money that would be far better spent making sick people well. So, it is our job. Its our job to search out the latest regulations and apply them. Its our job to remain up to date on payer changes, coverage determinations and policies. Its our job to share this knowledge with others. Its our job to go over and above, to code and submit proper claims for payment, and to make certain that we strive to work ethically. Its our job to be the best!
Lorem Ipsum
Detailed Written Orders and Face to Face Encounters CMS will start actively enforcing and will expect full compliance with the DME face-to-face requirements beginning on October 1, 2013. The written order for the DME must include, at a minimum: 1. The beneficiary's name, 2. The item of DME ordered, 3. The prescribing practitioner's National Provider Identifier (NPI), 4. The signature of the ordering practitioner and, 5. The date of the order. Key points of the requirement are: Documentation must show the physician, Physician Assistant (PA), Nurse Practitioner (NP) or Certified Nurse Specialist (CNS) had a face-to-face encounter examination with a beneficiary in the six months prior to the written order for certain items of Durable Medical Equipment (DME). DME ordered by a PA, NP, or CNS or a physician must document the occurrence of a face-to-face encounter by signing/co-signing and dating the pertinent portion of the medical record.
Physicians will be provided an additional payment, using code G0454, for signing/co-signing the face-to-face encounter of the PA/NP/CNS. Note that the G code may only be paid to the physician one time per beneficiary per encounter, regardless of the number of covered items documented in the face-to-face encounter. For more Information: http://www.cms.gov/Outreach-andEducation/Medicare-LearningNetworkMLN/MLNMattersArticles/Downloa ds/MM8304.pdf
With the application, you must submit two letters of recommendation verifying the number of instruction hours or amount of practical experience working in a coding capacity. The letters must come from a supervisor or previous supervisor. A letter may come from a teacher to verify classroom instruction hours. Upon passing the exam(s), you earn the title of Certified Professional Coder (CPC).
A membership fee to AAPC is also a requirement to take the exam. You must maintain membership with AAPC, plus submit 36 CEUs every two years to maintain certification. If you do not pass the exam on the first try, you can retake it again within one year for free. How can you prepare for the certification exam? Take Basic Medical Coding Take Intermediate Medical Coding Take a review course: o Our local AAPC Chapter also provides a review course for the certification exam. Contact the local chapter officers or Loretta Swan at lswa@tjc.edu for more information on dates/location of the review course. o Carol Buck, the author of your Step-by-Step coding textbook, works closely with AAPC. She has written a study guide called CPC PHYSICIAN EXAM REVIEW, THE CERTIFICATION STEP. This is the one I used. It contains two full-length practice coding exams with answers and rationale plus other helpful information for review. I felt very well prepared when I took the test, and after the test, I felt confident that I had passed which I did! The textbook can be purchased online at www.elsevierhealth.com. o AAPC offers an online study course that (Ive heard) is pretty good. AAPC only allows the standard or professional editions of the coding manuals ICD, CPT, and HCPCS. It is important to have the current year code books for the year the exam is taken. Please check out the website, and let me know if you have additional questions. Judy Young jyou@tjc.edu
Remember: Medicare requires that services provided/ordered be authenticated by the author. The method used shall be a hand written or an electronic signature. Stamp signatures are not acceptable. For more information: https://www.novitassolutions.com/em/mr-sign-req.html
Attention Coders!
Do you have submissions, photos, documents, stories, or other useful content to include in future editions that you would like to share? If so, send your information to: swanloretta@gmail.com for consideration in an upcoming newsletter.