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Compliance, Coding, and
Reimbursement
Medical billing and coding
regulations play an integral part in defining reimbursement in healthcare
organizations, providing accurate documentation, coding, and submission of
medical claims that affect reimbursement received by providers. Below is an
overview of how these regulations impact reimbursement as well as tasks
performed by various healthcare departments during this process:
Patient Registration: The Registration
department gathers patient demographic and insurance data accurately in order
to avoid claim denials or delays in reimbursement. Accuracy in data entry is of
utmost importance as any errors could lead to claim denials or delays in
reimbursement.
Coding and Documentation:
Healthcare providers and medical coders collaborate closely in assigning
appropriate medical codes for diagnoses, procedures, and services provided to
patients. ICD-10-CM codes represent diagnoses while CPT or HCPCS codes represent
procedures. Ultimately, an accurate representation of patient interactions are
achieved.
Charge Capture: Charge capture involves documenting all billable services, procedures, and supplies provided during patient visits in order to allow for accurate reimbursement of expenses. This helps ensure nothing is missed out when collecting payments...
