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The chargemaster may be alternatively referred to as the "charge master", "hospital chargemaster", or the "charge description master" (CDM). [4] [5] It is a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider. [3] [6] It is described as "the central mechanism of the revenue cycle" of a hospital ...
The National Uniform Billing Committee (NUBC) is the governing body for forms and codes use in medical claims billing in the United States for institutional providers like hospitals, nursing homes, hospice, home health agencies, and other providers. The NUBC was formed by the American Hospital Association (AHA) in 1975. [3]
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]
An important aspect of the revenue cycle is compliance with medical coding regulations. Such regulations generally require keeping track of what treatments are provided to patients and for what reason, and medical coding is a standardized way of record such information (and sharing it with third parties, such as insurers).
The acronym HCPCS originally stood for HCFA Common Procedure Coding System, a medical billing process used by the Centers for Medicare and Medicaid Services (CMS). Prior to 2001, CMS was known as the Health Care Financing Administration (HCFA).
Utilization Flags combine information from Uniform Billing (UB-04) revenue codes and ICD-9-CM or ICD-10-PCS procedure codes to create flags—or indicators—of utilization of services rendered in healthcare settings such as hospitals, emergency departments, and ambulatory surgery centers.
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.
The CPT code revisions in 2013 were part of a periodic five-year review of codes. Some psychotherapy codes changed numbers, for example 90806 changed to 90834 for individual psychotherapy of a similar duration. Add-on codes were created for the complexity of communication about procedures.