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PHI in Medical Coding

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 PROTECTED HEALTH INFORMATION (PHI) PHI stands for Protected Health Information and is any information in a medical record that can be used to identify an individual, and that was created, used, or disclosed in the course of providing a health care service, such as a diagnosis or treatment. In other words, PHI is personally identifiable information in medical records, including conversations between doctors and nurses about treatment. PHI also includes billing information and any patient-identifiable information in a health insurance company's computer system. Protected Health Information is the definition used by HIPAA (Health Insurance Portability and Accountability Act) to define the type of patient information that falls under the jurisdiction of the law. eHealth applications that collect, store or share PHI need to follow HIPAA compliance guidelines in order to be compliant with the law. In order for health data to be considered PHI and regulated by HIPAA it needs to be two th...
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Modifier in Medical Coding

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  MODIFIERS 59, 25 AND 91: A GUIDE FOR CODERS “If it isn’t coded then it hasn’t been done,” is a proverb that isn’t heard in the healthcare setting frequently enough. Correctly applying modifiers, though, isn’t always as cut and dry as it seems. Many times providers inappropriately use modifiers, an abuse that inevitably leads to claim denials. MODIFIERS 59, 25 AND 91: A GUIDE FOR CODERS “If it isn’t coded then it hasn’t been done,” is a proverb that isn’t heard in the healthcare setting frequently enough. Correctly applying modifiers, though, isn’t always as cut and dry as it seems. Many times providers inappropriately use modifiers, an abuse that inevitably leads to claim denials. Learn about the pros and cons of in-house billing vs. outsourced medical billing. Click here. “Modifiers are essential tools in the coding process,” says Laura Reeds, director of coding compliance at IASIS Healthcare in Franklin, Tenn. “They clarify how things should be paid … and further explain or qua...
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Z-Codes in Medical Coding

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 An Introduction to ICD-10 Z Code In the last decade, there has been an increase in mental health conditions and substance use disorders observed across the globe. Whereas such conditions may vary from mild to severe and are treatable, physicians often find them difficult to code and bill.  Generally, behavioral health physicians rely on the International Classification of Disease (ICD) by the World Health Organization as a tool for medical diagnoses. From time to time, WHO issues updates to the ICD, with ICD-10 being the latest version. It is from the ICD that the US developed clinical modifications, meaning physicians adhere to ICD-10-CM.   One of the primary reasons that coding and billing are so complex and cumbersome is the need to provide detailed justification for the services that you provide. Unfortunately, the 70,000 different codes that describe conditions, signs, symptoms, complaints, findings, and external causes of injury do not aid this process.  ...
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Location: Rahath Towers Tc 48/48 (2),By Pass Road Ambalathara Junction, opp. BM Convention Centre, Ambalathara, Thiruvananthapuram, Kerala 695026, India
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ERA in Medical Coding

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  Why ERAs Are More Efficient than EOBs It is no secret that the healthcare industry is burdened with costly administrative processes. A good example of this are paper explanation of benefits (EOB) forms that have been estimated to cost nearly $18,600 per physician per year in administrative fees. With the availability of tools like the electronic remittance advice (ERA), medical practices, hospitals, billing companies and other healthcare providers can jump on the paperless bandwagon and reduce these exorbitant administrative costs. An electronic remittance advice (ERA) — or what is frequently referred to as the HIPAA 835 file — is essentially an electronic EOB. ERAs contain information on whether a claim was paid or denied, final status claims and any adjustments the payer made to the billed amount. The Affordable Care Act (ACA) requires health plans to implement ERAs under Stage 2 of its Administrative Simplification provision. This represents a strong incentive for payers like...
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Location: Rahath Towers Tc 48/48 (2),By Pass Road Ambalathara Junction, opp. BM Convention Centre, Ambalathara, Thiruvananthapuram, Kerala 695026, India
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EMR in Medical Coding

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  EMR/EHR Coding : What you need to know? It comes as no surprise that the medical industry is becoming digitized every day. Thanks to all the new CPT updates, ICD codes, and other coding trends that are making a way to revolutionize the entire realm. EMR/EHR coding has also transformed the way patient records are collected, recorded, and processed. When it comes to EMR/EHR coding, the size of the entire market will grow at a CAGR (Compound Annual Groth Rate) of 10.9% and increase from $70 billion to $120 billion, by the end of 2023. As a part of the Health HITECH Act of 2009, the federal government has also allocated $25.9 billion for encouraging certified providers. Considering these statistics, you should not be holding back from adopting EMR/EHR coding system at your facility. Don’t know where to start? Read all the essential details in this post. Appropriate Standards and Protocols Some of the must follow protocols for an EMR/EHR Coding system include Current Procedural Termin...
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Location: Rahath Towers Tc 48/48 (2),By Pass Road Ambalathara Junction, opp. BM Convention Centre, Ambalathara, Thiruvananthapuram, Kerala 695026, India
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CMS in Medical Coding

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  Reimbursement and regulatory functions In addition to Medicare (the federal health insurance program for the elderly) and Medicaid (the federal needs-based program that helps with medical costs), CMS administers the Children's Health Insurance Program (CHIP), the Health Insurance Portability and Accountability Act (HIPAA) and key portions of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) law. MACRA includes programs such as Merit-Based Incentive Payment System (MIPS) in which physicians and healthcare organizations are reimbursed based on their scores on healthcare quality and patient satisfaction measures. The approach is also known as value-based reimbursement. CMS also administers alternative payment models (APMs) for healthcare providers such as bundled payments for groups of healthcare organizations, and accountable care organizations, which are reimbursed based on positive medical outcomes. Since passage of the Health Information Technology for Economic and C...
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ICD in Medical Coding

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  What are ICD-10 codes and why are they important for doctors ? The International Classification of Disease (ICD) is a standard diagnostic tool created by the World Health Organization (WHO), for monitoring the incidence and prevalence of diseases and related conditions. The ICD has diverse clinical applications, and is used not just by doctors but also by paramedic staff, insurance companies, researchers and policy makers. ICD is used to classify diseases and store diagnostic information for clinical, quality and epidemiological purposes and also for reimbursement of insurance claims. What is ICD-10 The ICD tenth revision (ICD-10) is a code system that contains codes for diseases, signs and symptoms, abnormal findings, circumstances and external causes of diseases or injury. The need for ICD-10 Created in 1992, ICD-10 code system is the successor of the previous version (ICD-9) and addresses several concerns. ICD-10 codes are updated on a yearly basis, allowing addition, deletion...
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