Synopses & Reviews
CAPSTONE SIMULATION FOR CODING will help you bridge the gap between classroom and work experience. It provides a 'virtual externship' that allows you to take what you have learned in the classroom and applies it with on-the-job scenarios typically performed by a medical coding and billing specialist. CAPSTONE SIMULATION FOR CODING simulates 80-hours of real world activities in two different scenarios. Spend one week in a medical practice performing administrative billing tasks; the second week, coding for a multi-specialty ambulatory surgery center as an employee of a remote coding company.
Review
"I would recommend the text as another option for our Medical Office Administration degree program because there is nothing appropriate at this time to address the program's externship option. Learners in [our] Medical Office Assistant program are not required to perform an externship and this text would be an excellent option for them"Tina M. Williams MSHSA CPCPresident San Francisco Medical Coding InstituteFaculty Heald College SFCSan Francisco California
Review
"I would definitely recommend this text for adoption. It can be utilized as a tool in a Medical Office Simulation Course and as part of a student's externship requirement."June M. Petillo MBA; RMCInstructor - Medical Assisting ProgramManchester Community College and Capitol Community College Manchester and Hartford CT
About the Author
Stacey Mosay has over 16 years experience in health information management as a Director of Medical Records for a multi-hospital health system. Ms. Mosay owns her own consulting company entitled Private Practice Solutions where she provides operational analysis of physician practices coding and billing education medical record audits coding and billing revenue cycle management and temporary staffing. She served five years as the Medical Record Coder Program Coordinator and instructor for the academic Coding Certificate program in the Division of Allied Health at Trident Technical College. She is a graduate of the Medical University of South Carolina with a B.S. in Health Information Management. She served as chairman of the AHIMA CCA test construction committee from 2006-2007. She is a registered member of the American Health Information Management Association and the American Academy of Professional Coders. She is a member of the Low Country Coders Association the Palmetto Coder Association AHIMA's Assembly of Education American Medical Billing Association and Healthcare Billing and Management Association. Stacey also serves as a coding and billing text book auditor/reviewer and author for Delmar Cengage Learning (formerly Thomson Delmar Learning) and McGraw- Hill Publishing.
Table of Contents
Chapter 1 ORIENTATION TO DOUGLASVILLE MEDICINE ASSOCIATES Objectives Welcome From the Doctors Purpose of Course Introduction Orientation to the Clinic Mission Values Organizational Structure and Staff Coder Competencies Coder Job Duties HIPAA and Patient Confidentiality Patient Bill of Rights Notice of Privacy Practices HIPAA Security Authorization to Release Medical Information Consent for Use of Protected Health Information Electronic Health Care Transactions and Code Sets HIPAA National Identifiers DMA Compliance Plan Human Relations Policies and Procedures Chapter 2 COMPUTERS IN HEALTHCARE Information Technology Advantages of Computerization in the office Technology in Health Care Administration Personal Data Assistant (PDA) Local Area Network (LAN) Wide Area Network (WAN) Virtual Private Network (VPN) Smart Card Software Encoder Internet Telemedicine LISTSERV HTML Electronic Data Interchange (EDI) HIPAA Transaction Code Sets Electronic Funds Transfer (EFT) Clearinghouse Edit Electronic Remittance Advice (ERA) Autoposting Internet uses and websites for Coders Electronic Medical Record (EMR) Computer down time Chapter 3 Medical Insurance Flow of Patient Information Medical Records Building patient files Insurance Terminology Review Insurance Verification Co-pay Coinsurance Assignment of Benefits Medical Insurance Review Insurance Coverage Credentialing Government Sponsored Health Care Programs Medicare Medicaid Tricare Workers Compensation Managed Care Introduction to the Revenue Cycle Scheduling Registration Charge Entry Coding Billing CMS 1500 Claim Form Preparation Collections Insurance Follow-up Chapter 4 MOSS ORIENTATION AND TRAINING Scheduling Registration Coding/Abstracting Billing/Printing statements Payments and Adjustments Reading EOBs Printing Reports Daily procedures/reports Chapter 5 CODING Coding Guidelines Review Medical Record Contents Patient Information Sheet Encounter Form (Router) Patient Assessment History and Physical Physician Orders Medication List Progress Notes SOAP Notes Laboratory Reports Radiology Reports Consent Forms Pathology Report Source Documents How to Code a Diagnosis From a Record How to Assign CPT Codes From a Record Medical Necessity Local Coverage Determinations Obtaining LCDs Coder Responsibilities Correct Coding Initiative (CCI) Unbundling CCI Edits Column 1 Column 2 Denials from Edits Mutually Exclusive Steps for Using Edits Coding Compliance False Claims Physician Extenders Incident To Coding Exam PART III WORKING IN THE CLINIC Chapter 6 FRONT DESK Day One Jobs 1 Read DMAs Policy and Procedure Manual Job 2 Computerized File Maintenance Updating fees and CPT code List in MOSS Job 3 Computerized Scheduling (setting up in MOSS) Blocking off days for holidays Job 4 Changing hours on Fridays Blocking off hours Job 5 File Maintenance Creating visit code for office consultation and cancellation code for no-show Job 6 Scheduling appointment for Francesco Alvarez Job 7 Scheduling appointment for Melissa Morency Job 8 Registering a walk-in patient John Wittmer. Adding appointment to schedule Job 9 Checking out Mr. Alvarez and collecting money Job 10 Scheduling appointment for William Kostner and adding a new insurance carrier to MOSS. Job 11 Checking out Mr. Wittmer and collecting money. Job 12 Scheduling appointment for Samantha Beechwood Job 13 Scheduling new patient appointment for Hugh Williams Job 14 Scheduling appointment for Ryan Ashby Job 15 Scheduling new patient appointment for Brian McDonough Job 16 Checking out Mr. Ashby. Collecting money and drafting a payment plan. Job 17 Changing address for Signal HMO in MOSS. Job 18 Scheduling appointment for Naomi Yamagata Job 19 Scheduling appointment for Paul Morgan Job 20 Changing appointment time for Ms. Yamagata Job 21 Scheduling new patient appointment for William Turner Job 22 Scheduling appointment for Laura Leighton Job 23 Scheduling appointment for Caitlin Barrymore Job 24 Checking Mr. Turner in, making his folder, and checking his benefits Job 25 Scheduling new patient appointment for Julius Washington Job 26 Checking Mr. Turner out. Collecting money. Dealing with a difficult situation. Patient is out of network and angry. Job 27 Registering and checking out Caitlin Barrymore. Collecting money. Figuring coinsurance. Job 28 Appointment confirmations for next day appointments. Job 29 Checking out Laura Leighton. Collecting money Job 30 Checking out Ms. Yamagata. Scheduling a follow up appointment. Collecting money. Job 31 Scheduling an appointment for Isabel Durand Job 32 Scheduling appointment for Deanna Hartsfield Job 33 Scheduling appointment for Wilma Steam Job 34 Checking insurance benefits for patients on schedule tomorrow. Job 35 Completing daily deposit Job 36 Printing schedule for tomorrow Day Two Job 1 Walk in patient Richard Manaly. Adding appointment to schedule, checking him in, verifying his insurance. Job 2 Registering Brian McDonough and making his folder. Job 3 Checking out Mr. Manaly. Calculating coinsurance. Collecting money. Job 4 Registering Wilma Steam Job 5 Checking out Mr. McDonough Calculating daily charges. Calculating coinsurance. Collecting money. Job 6 Registering Isabel Durand. Explaining Medicares policy on pelvic exams and PAP smears. Obtaining ABN. Job 7 Checking out Ms. Steam and collecting copay. Job 8 Registering Julius Washington and making his folder. Job 9 Checking out Ms. Durnad. Calculating coinsurance. Collecting money. Job 10 Scheudling appointment for Russell Logan Job 11 Scheduling appointment for Edward Gorman. Job 12 Checing out Mr. Washington. Calculaing coinsurance and collecting money. Job 13 Regisering William Kostner and making his folder. Job 14 Scheduling an appointment for Ted Mosby. Job 15 Checking out Mr. Kostner. Changing his insurance in the computer. Deciding if he owes money. Job 16 Checking insurance precertification for Paul Morgans vasectomy. Job 17 Checking out Ms. Hartsfeld. Calculating coinsurance and collecting money. Job 18 Processing walk-in patient Derek Wallace. Adding him to the schedule and checking his insurance benefits. Job 19 Checking out Mr. Mangano. Determining what to collect from him. Collecting money. Job 20 Checking out Mr. Wallace. Collecting his copay. Job 21 Registering Melissa Morency and making her folder. Checking her insurance benefits. Job 22 Scheduling appointment for Barry Jurch Job 23 Registering Samantha Beechwood and making her folder. Analyzing problem with her paperwork. Job 24 Scheduling appointment for Alan Shuman. Job 25 Checking Ms. Morency out. Determining which insurance is primary. Calculating coinsurance. Job 26 Checking out Ms. Beechwood. Collecting copay. Job 27 Canceling appointment for Cynthia Worthington Job 28 Scheduling appointment for Emery Camille Job 29 Scheduling appointment for Diane Parker Job 30 Scheduling John Connell Job 31 Checking insurance benefits on all patients for tomorrow. Job 32 Confirming appointments on schedule for tomorrow Job 33 Completing daily deposit Chapter 7 CHARGE CAPTURE Day 3 Job 1 Code visits from routers for Monday and Tuesday Job 2 Check CCI edits for Derek Wallaces visit Job 3 William Kostner- determining consult vs. referral Job 4 Code hospital visits Job 5 Research telemedicine reimbursement policies for three carriers. Job 6 Audit the encounter form Job 7 Check preauthorization with Carolina Care Plan for continuous glucose biographer Job 8 Create charge codes for no-shows and insufficient checks Job 9 Determining primary insurance for Samantha Beechwood Job 10 Entering charges for office visits 10/26/09-10/27/09 Job 11 Entering charges for hospital visits Job 12 Assessing fee for No-Show patient and writing letter Job 13 Printing day sheet Job 14 Printing hard copy claims and sending electronic claims Day 4 Job 1 Registering Paul Morgan and Hugh Williams. Creating new patient charts. Job 2 Coding routers for 10/28/09 Job 3 Coding hospital charges Job 4 Coding Hugh Williams. Researching Medicare NCD. Job 5 Preventative and sick visit during same encounter Job 6 Coding visit for Chrissy Krouse Job 7 Prolonged visit Job 8 Coding Amy Bradleys visit Job 9 Home health care plan oversight Job 10 Researching NCD bone density measurements. Discussing policy with patient and obtaining waiver Job 11 Researching CLIA waived tests. Determining modifier used with waived tests. Job 12 Entering charges for 10/28/09 routers. Job 13 Entering charges for hospital visits Job 14 Print day sheet for 10/29/09 Job 15 Research Medicare timely filing guidelines. Job 16 Electronically release claims Chapter 8 PAYMENTS, COLLECTIONS AND REPORTING Jobs 1-7 Posting payments from patients and transactions from Remittance Advice Jobs 8-9 Secondary Claims Jobs 10-16 Insurance Denials Jobs 17-20 Collections and Print Patient Statements Job 21 Reporting PART IV CODING INTERNSHIP Chapter 9 WORKING FOR AN OUTSOURCING CODING COMPANY Introduction to Internship Outsourcing Introduction to Remote coding Orientation to Surgery Coding Solutions Conditions of Employment Work Flow Orientation to Meadway MedSurg Clinic Encoder Pro Assigned Work Ambulatory Surgery Center Coding Tips PART V APPENDICES Appendix A Company Policy and Procedure Manual (including coding policies) Appendix B Insurance Contracts/Medicare Fee schedule Appendix C AHIMA Standards of Ethical Coding Appendix D Procedure Fee Schedule Appendix E Credentialing Application Appendix F E/M Coding Tool Appendix G Patient Record Content and Source Documents Appendix H Coding Capture Form Appendix I Payment Plan Appendix J Deposit Slip Appendix K Employee Privacy Acknowledgement and Employee Policy Manual Acknowledgement