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  2. Current Procedural Terminology - Wikipedia

    en.wikipedia.org/wiki/Current_Procedural_Terminology

    (99324–99337) Domiciliary, rest home (boarding home) or custodial care services (99339–99340) Domiciliary, rest home (assisted living facility), or home care plan oversight services (99341–99350) Home health services (99354–99360) Prolonged services (99363–99368) Case management services (99374–99380) Care plan oversight services

  3. Evaluation and Management Coding - Wikipedia

    en.wikipedia.org/wiki/Evaluation_and_Management...

    Evaluation and management coding (commonly known as E/M coding or E&M coding) is a medical coding process in support of medical billing. Practicing health care providers in the United States must use E/M coding to be reimbursed by Medicare , Medicaid programs, or private insurance for patient encounters.

  4. Medical billing - Wikipedia

    en.wikipedia.org/wiki/Medical_billing

    Achieving a high clean claims rate is a key metric for measuring the efficiency of the billing cycle. Creation of the claim is where medical billing most directly overlaps with medical coding because billers take the ICD/CPT codes used by the medical coders and creates the claim. Step 6: Monitoring payor Adjudication [4]

  5. Healthcare Common Procedure Coding System - Wikipedia

    en.wikipedia.org/wiki/Healthcare_Common...

    HCPCS includes three levels of codes: Level I consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric.; Level II codes are alphanumeric and primarily include non-physician services such as ambulance services and prosthetic devices, and represent items and supplies and non-physician services, not covered by CPT-4 codes (Level I).

  6. Chargemaster - Wikipedia

    en.wikipedia.org/wiki/Chargemaster

    According to Essentials of Managed Health Care, as of 2012 the chargemaster file typically included between 20,000 and 50,000 price definitions. [ 13 ] [ 14 ] The Lewin Group analyzed utilization of the chargemaster and found that a low proportion of hospitals carried out regular reviews of their chargemaster implementation. [ 15 ]

  7. Clinical coder - Wikipedia

    en.wikipedia.org/wiki/Clinical_coder

    The basic task of a clinical coder is to classify medical and health care concepts using a standardised classification. Inpatient, mortality events, outpatient episodes, general practitioner visits and population health studies can all be coded. Clinical coding has three key phases: a) abstraction; b) assignment; and c) review. [5]

  8. Clinical Care Classification System - Wikipedia

    en.wikipedia.org/wiki/Clinical_Care...

    Codes based on ICD-10 (WHO, 1992) structure for information exchange promoting interoperability. Uses a coding structure of five alphanumeric digits to link the two CCC System terminologies to each other and to map to other EHR/HIT systems. Designed for determining workload (productivity), resources (needs), outcomes (quality), and care costs.

  9. Utilization management - Wikipedia

    en.wikipedia.org/wiki/Utilization_management

    Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...

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