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| case management billing guidelines: The Leader's Guide to Hospital Case Management Stefani Daniels, Marianne Ramey, 2005 This text will address the role of the hospital case manager from a busniess perspective rather than a nursing perspective. Will engage all areas that are involved with the health care system, in pursuit of global objectives on behalf of every stakeholder. |
| case management billing guidelines: Health and Human Services Issues United States. General Accounting Office, 1993 Discussing major policy, management, and program issues facing Congress and the Clinton administration in the area of health and human services, this pamphlet provides recommendations for the Department of Health and Human Services (HHS) regarding the social security system, the welfare system, preventing child abuse, and safeguarding the nation's food supply. Following an overview of important issues facing the nation, the second section suggests steps to bolster public confidence in the social security system, including building the system's trust fund by increasing contribution levels and modernizing computer systems. The next section provides recommendations for continuing the welfare reform movement and the implementation of the Family Support Act, such as developing automated data systems to effectively manage caseloads, setting goal-oriented program performance standards, and identifying and sharing effective initiatives between states. The fourth section suggests that HHS provide states with greater flexibility in using government funds to prevent child abuse through early intervention and that a national foster care system be developed to provide outcome-oriented data on child welfare services. The final section proposes that an agency-wide system for tracking regulation development be implemented in the Food and Drug Administration to improve agency effectiveness and better allocate existing resources. Includes references for 22 related GAO products. (BCY). |
| case management billing guidelines: ICD-10-CM Official Guidelines for Coding and Reporting - FY 2021 (October 1, 2020 - September 30, 2021) Department Of Health And Human Services, 2020-09-06 These guidelines have been approved by the four organizations that make up the Cooperating Parties for the ICD-10-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS. These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. The instructions and conventions of the classification take precedence over guidelines. These guidelines are based on the coding and sequencing instructions in the Tabular List and Alphabetic Index of ICD-10-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-10-CM diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (Tabular List and Alphabetic Index) have been adopted under HIPAA for all healthcare settings. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. These guidelines have been developed to assist both the healthcare provider and the coder in identifying those diagnoses that are to be reported. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated. |
| case management billing guidelines: The Social Determinants of Mental Health Michael T. Compton, Ruth S. Shim, 2015-04-01 The Social Determinants of Mental Health aims to fill the gap that exists in the psychiatric, scholarly, and policy-related literature on the social determinants of mental health: those factors stemming from where we learn, play, live, work, and age that impact our overall mental health and well-being. The editors and an impressive roster of chapter authors from diverse scholarly backgrounds provide detailed information on topics such as discrimination and social exclusion; adverse early life experiences; poor education; unemployment, underemployment, and job insecurity; income inequality, poverty, and neighborhood deprivation; food insecurity; poor housing quality and housing instability; adverse features of the built environment; and poor access to mental health care. This thought-provoking book offers many beneficial features for clinicians and public health professionals: Clinical vignettes are included, designed to make the content accessible to readers who are primarily clinicians and also to demonstrate the practical, individual-level applicability of the subject matter for those who typically work at the public health, population, and/or policy level. Policy implications are discussed throughout, designed to make the content accessible to readers who work primarily at the public health or population level and also to demonstrate the policy relevance of the subject matter for those who typically work at the clinical level. All chapters include five to six key points that focus on the most important content, helping to both prepare the reader with a brief overview of the chapter's main points and reinforce the take-away messages afterward. In addition to the main body of the book, which focuses on selected individual social determinants of mental health, the volume includes an in-depth overview that summarizes the editors' and their colleagues' conceptualization, as well as a final chapter coauthored by Dr. David Satcher, 16th Surgeon General of the United States, that serves as a Call to Action, offering specific actions that can be taken by both clinicians and policymakers to address the social determinants of mental health. The editors have succeeded in the difficult task of balancing the individual/clinical/patient perspective and the population/public health/community point of view, while underscoring the need for both groups to work in a unified way to address the inequities in twenty-first century America. The Social Determinants of Mental Health gives readers the tools to understand and act to improve mental health and reduce risk for mental illnesses for individuals and communities. Students preparing for the Medical College Admission Test (MCAT) will also benefit from this book, as the MCAT in 2015 will test applicants' knowledge of social determinants of health. The social determinants of mental health are not distinct from the social determinants of physical health, although they deserve special emphasis given the prevalence and burden of poor mental health. |
| case management billing guidelines: Justcoding's Practical Guide to Coding Management Rose T. Dunn, 2016-10-01 JustCoding's Practical Guide to Coding Management Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS ICD-10's arrival changed more than code selection--it's also brought challenges related to coder productivity, coding quality and accuracy, staffing shortages, coder education and training, and the increased need for auditing. The old rules and standards for running a department no longer apply, and coding managers must update their efforts, just as coders themselves have. This book gives coding managers new benchmarks, standards, and tips to ensure they're running an effective coding department. It provides strategies for coder retention, best practices to balance internal and outsourced coders, and tips for managing on-site and remote staff. The book also provides much-needed information for managers on how to educate their teams on coding's role within the revenue cycle. |
| case management billing guidelines: CPT 2021 Professional Edition American Medical Association, 2020-09-17 CPT® 2021 Professional Edition is the definitive AMA-authored resource to help health care professionals correctly report and bill medical procedures and services. Providers want accurate reimbursement. Payers want efficient claims processing. Since the CPT® code set is a dynamic, everchanging standard, an outdated codebook does not suffice. Correct reporting and billing of medical procedures and services begins with CPT® 2021 Professional Edition. Only the AMA, with the help of physicians and other experts in the health care community, creates and maintains the CPT code set. No other publisher can claim that. No other codebook can provide the official guidelines to code medical services and procedures properly. FEATURES AND BENEFITS The CPT® 2021 Professional Edition codebook covers hundreds of code, guideline and text changes and features: CPT® Changes, CPT® Assistant, and Clinical Examples in Radiology citations -- provides cross-referenced information in popular AMA resources that can enhance your understanding of the CPT code set E/M 2021 code changes - gives guidelines on the updated codes for office or other outpatient and prolonged services section incorporated A comprehensive index -- aids you in locating codes related to a specific procedure, service, anatomic site, condition, synonym, eponym or abbreviation to allow for a clearer, quicker search Anatomical and procedural illustrations -- help improve coding accuracy and understanding of the anatomy and procedures being discussed Coding tips throughout each section -- improve your understanding of the nuances of the code set Enhanced codebook table of contents -- allows users to perform a quick search of the codebook's entire content without being in a specific section Section-specific table of contents -- provides users with a tool to navigate more effectively through each section's codes Summary of additions, deletions and revisions -- provides a quick reference to 2020 changes without having to refer to previous editions Multiple appendices -- offer quick reference to additional information and resources that cover such topics as modifiers, clinical examples, add-on codes, vascular families, multianalyte assays and telemedicine services Comprehensive E/M code selection tables -- aid physicians and coders in assigning the most appropriate evaluation and management codes Adhesive section tabs -- allow you to flag those sections and pages most relevant to your work More full color procedural illustrations Notes pages at the end of every code set section and subsection |
| case management billing guidelines: HIV Psychiatry James A. Bourgeois, Mary Ann Adler Cohen, Getrude Makurumidze, 2021-11-18 This book is a practical guide in understanding how to prevent HIV transmission, to recognize risk behaviors, and to add something else to their repertoires. It aims to empower clinicians and provide a sense of security and competence with the recognition and understanding of some of the psychiatric illnesses that complicate and perpetuate the HIV pandemic that continue to persist throughout every area of the world despite the magnitude of the progress that has transformed the illness from a rapidly fatal to chronic illness that is no longer life-limiting. Missing in most of the literature on HIV is the subtle, and sometimes not so subtle, contribution of psychiatric symptoms, psychiatric illness, and risk behaviors that drive the pandemic and serve as catalysts for new infections. This practical guide provides state-of-the-art understanding of not only prevention but also a way to recognize risk behaviors, psychiatric symptoms, and psychiatric illnesses that will demystify and decode the sometimes enigmatic and frustrating reasons for nonadherence with diagnostic procedures and life-saving treatments and care. All behaviors and pathology are covered as well as the resources and treatments available. The goal of this text is to refresh knowledge on the current state of psychiatric illness management among people living with HIV, to provide a concise volume on the psychiatric aspects of HIV prevention and treatment that substantially impact the overall care of the patient, and to help understand the psychiatric catalysts of the pandemic Written by experts in the field, HIV Psychiatry: A Practical Guide for Clinicians provides enduring guidance to medical and other professionals caring for complicated clinical patients as they face ongoing challenges in working with persons with HIV and AIDS. |
| case management billing guidelines: US Army Physician Assistant Handbook , 2018 The Army physician assistant (PA) has an important role throughout Army medicine. This handbook will describe the myriad positions and organizations in which PAs play leadership roles in management and patient care. Chapters also cover PA education, certification, continuing training, and career progression. Topics include the Interservice PA Program, assignments at the White House and the Old Guard (3d US Infantry Regiment), and roles in research and recruiting, as well as the PA's role in emergency medicine, aeromedical evacuation, clinical care, surgery, and occupational health.--Amazon.com viewed Oct. 29, 2020. |
| case management billing guidelines: CMSA Core Curriculum for Case Management Hussein M. Tahan, Teresa M. Treiger, 2016-07-05 The fully updated CMSA Core Curriculum for Case Management, 3rd edition, is the definitive roadmap to an informed, effective, collaborative case management practice. This comprehensive, expertly-written guide provides those directly or indirectly involved in case management with information about best practices, descriptions of key terms, essential skills, and tools that fulfill the current Case Management Society of America’s (CMSA) standards and requirements. Addressing the full spectrum of healthcare professional roles and environments, this is both a crucial certification study guide and vital clinical resource for the case management professionals in all specialty areas, from students to veteran case managers. This unique resource provides the core knowledge needed for safe, cost-effective case management with the following features ... NEW text boxes highlighting key information and vital practices in each chapter NEW and updated Standards of Practice implications in each chapter NEW and updated content on transitions of care, community-based care, care coordination, Value-Based Purchasing, ethics and social media, the impacts of health care reform, and digital technology NEW and updated content on accreditation in case management NEW chapter that lists key additional resources, by topic Official publication of the Case Management Society of America, connecting CMSA core curriculum to current CMSA Standards of Practice Easy-to-grasp, detailed topical outline format for quick scan of topics Complete, updated core knowledge required of case managers, with expert descriptions and direction on areas including: Case management roles, functions, tools, and processes Plans, clinical pathways, and use of technology Transitional planning Utilization management and resource management Leadership skills and concepts Quality and outcomes management; legal and ethical issues Education, training, and certification Health care insurance, benefits, and reimbursement systems Practice settings and throughput Interdisciplinary teams’ needs in: hospitals, community clinics, private practice, acute care, home care, long-term care and rehab settings, palliative care, and hospice settings Up-to-date guidance on case management specialty practices, including: nursing, life care planning, workers’ compensation, disability management, care of the elderly, behavioral health, transitions of care, subacute and long-term care, utilization review/management, primary care and medical/health home, and more Essential content for academic reference, training, certification study, case management models design, performance or program evaluation |
| case management billing guidelines: A Guide for Nurse Case Managers Charlotte Cox, 2010-08-12 The position of nurse case managers can be a rewarding but challenging career, as these managers play a vital role in a patient’s care. In A Guide for Nurse Case Managers, author Charlotte Cox provides an insightful guide to this evolving field of medicine. Geared for those working in hospital settings, clinics, and health plan offices, this helpful reference text provides guidelines, tips, and tools for becoming a successful nurse case manager. With more than thirty years of health care experience, Cox provides a detailed overview of this important nursing position that works to usher a patient through the health care system. A Guide for Nurse Case Managers • defines the case manager role; • provides an understanding of the basics of utilization and case management; • gives an overview of Medicare and Medicaid procedures; • discusses the care planning process; • shows how to structure a community resource base. Whether you are a new case manager, a student, or a seasoned nurse needing a refresher about job basics, A Guide for Nurse Case Managers will help to shape your practice, provide valuable tips and reference tools, and help you with proven organizational ideas to succeed in the career. |
| case management billing guidelines: CMSA Core Curriculum for Case Management , 2008 This text contains the core body of knowledge for case management practice as delineated by the Case Management Society of America (CMSA), the largest professional organization of case managers. The core curriculum provides a synthesis of case management evolution, and presents essential elements, concepts, and vision for current and future case management practice. This edition is significantly expanded to reflect the dynamic changes taking place in case management. Each chapter is organized in a consistent format that includes learning objectives; introduction; important terms and concepts; key definitions; and references. |
| case management billing guidelines: A Case Manager’s Study Guide Skinner, Stefany H Almaden, 2018-03-20 Preceded by A case manager's study guide / Denise Fattorusso, Campion Quin. 4th ed. c2013. |
| case management billing guidelines: A Case Manager's Study Guide Denise Fattorusso, Campion Quinn, 2004 This is the most comprehensive print and electronic combination study guide case management certification! It contains the most up-to-date information, assures a uniform base knowledge for the successful case manager, and provides: study questions and practice exams to help you assess your skills and needs. |
| case management billing guidelines: ICD-9-CM Official Guidelines for Coding and Reporting , 1991 |
| case management billing guidelines: Ask a Manager Alison Green, 2018-05-01 From the creator of the popular website Ask a Manager and New York’s work-advice columnist comes a witty, practical guide to 200 difficult professional conversations—featuring all-new advice! There’s a reason Alison Green has been called “the Dear Abby of the work world.” Ten years as a workplace-advice columnist have taught her that people avoid awkward conversations in the office because they simply don’t know what to say. Thankfully, Green does—and in this incredibly helpful book, she tackles the tough discussions you may need to have during your career. You’ll learn what to say when • coworkers push their work on you—then take credit for it • you accidentally trash-talk someone in an email then hit “reply all” • you’re being micromanaged—or not being managed at all • you catch a colleague in a lie • your boss seems unhappy with your work • your cubemate’s loud speakerphone is making you homicidal • you got drunk at the holiday party Praise for Ask a Manager “A must-read for anyone who works . . . [Alison Green’s] advice boils down to the idea that you should be professional (even when others are not) and that communicating in a straightforward manner with candor and kindness will get you far, no matter where you work.”—Booklist (starred review) “The author’s friendly, warm, no-nonsense writing is a pleasure to read, and her advice can be widely applied to relationships in all areas of readers’ lives. Ideal for anyone new to the job market or new to management, or anyone hoping to improve their work experience.”—Library Journal (starred review) “I am a huge fan of Alison Green’s Ask a Manager column. This book is even better. It teaches us how to deal with many of the most vexing big and little problems in our workplaces—and to do so with grace, confidence, and a sense of humor.”—Robert Sutton, Stanford professor and author of The No Asshole Rule and The Asshole Survival Guide “Ask a Manager is the ultimate playbook for navigating the traditional workforce in a diplomatic but firm way.”—Erin Lowry, author of Broke Millennial: Stop Scraping By and Get Your Financial Life Together |
| case management billing guidelines: Medical Fee Schedule , 1995 |
| case management billing guidelines: The Animal Doctor Tayo Amoz, 2008 |
| case management billing guidelines: The Case Manager's Handbook Catherine M. Mullahy, 2013-06-20 Written by renowned author Catherine Mullahy, The Case Manager’s Handbook, Fifth Edition is the ultimate how-to guide for case managers. This practical resource helps case managers build fundamentals, study for the Certified Case Manager (CCM) exam, and most importantly, advance their careers after the exam. Written for all professionals in all practice settings in case management, it uses real-life examples and an easy-to-read, conversational style to examine the case management process while presenting practical procedural information. An excellent daily reference and training guide for new case managers and seasoned professionals in various setting, The Case Manager’s Handbook, Fifth Edition is the “go-to” resource for facing the day-to-day challenges of case management, especially as the nation navigates through the many changes introduced by the landmark Patient Protection and Affordable Care Act. Significantly updated and revised, it contains eight new chapters: * Hospital Case Management: Changing Roles and Transitions of Care * Patient Centered Medical Home, ACOs, Health Exchanges * Evidence-Based Practice * Public Sector Reimbursement * Predictive Modeling * Pain Management * Health Technology, Trends, and Implications for Case Managers * The Affordable Care Act of 2010: Implications for Case Managers Included with each new print book is an Access Code for a Navigate Companion Website for students with objectives, multiple choice questions, and bonus appendices. |
| case management billing guidelines: The Lawyer's Guide to Practice Management Systems Software Andrew Zenas Adkins, 2009 What can practice management systems software do for a law practice? With the right system in place, a law firms and staff will have the ability to automatically route items, tasks, documents, and events to certain people based on their role in the case or matter, as well as manage deadlines, improve responsiveness to clients, reduce malpractice insurance rates, and boost overall productivity. The challenge is to find a program that best serves the needs of the firm. |
| case management billing guidelines: Case Management Suzanne K. Powell, Hussein M. Tahan, 2018-02-26 Prepare for a new career as a case manager—or just upgrade your skills to a whole new level—with the newly updated Case Management: A Practical Guide for Education and Practice, 4th Edition. Ideal for case management certification (CCMC) exam preparation, this is a thorough review of the case manager’s many roles and skills, from acute to post-acute care. Whether you are a nurse transitioning to case management or already active in it, this is your road map to coordinating successful patient care, from hospital to home. Build a strong case management career foundation, with expert, evidence-based direction: NEW chapter on case manager orientation programs that offers orientation checklists, competency assessment, and learning profiles, with available online tools NEW topics on current practice issues and developments, including the impact of the Patient Protection and Affordable Care Act and value-based care NEW content on experiential, problem-based learning—learning practices, training programs, case management team professional development Offers in-depth, evidence-based guidance on: The case manager’s roles, functions, and tasks Key concepts—quality management and outcomes evaluation, legal and ethical considerations, case management process, utilization management, transitions of care The role of the nurse case manager versus social worker role Strategies that ensure effectiveness of case management models Coordinating care, protecting privacy and confidentiality, health insurance benefit analysis, practice standards The Case Management Code of Professional Conduct, accreditation agencies and standards, specialty board certifications Management of resources and reimbursement concepts Case management in various settings—acute care, emergency department, admissions, perioperative services, disease management, insurance case management, palliative care, end-of-life care, hospice, home health care, physician groups, public health/community-based care, rehabilitation Ideal preparation for the CCMC exam—offers a large portion of CCMC exam content—and for Continuing Education Unit (CEU) for Case Management study A must-have desk reference that offers plentiful case studies—considered to be “the bible” of case management |
| case management billing guidelines: The Hospital Case Management Orientation Manual Peggy Rossi, Bsn, Mpa, CCM, Karen Zander, 2014-06-12 The Hospital Case Management Orientation Manual Guide is a comprehensive resource that supplements of initial training for new case managers. This book explains what to document, where to document it to ensure appropriate level of care and reimbursement, and how to avoid unnecessary denials. This book's focus is utilization management, discharge planning, and relevant CMS regulations. It can help new case managers learn how to perform their jobs effectively on their own time. It can also serve as a wide-ranging resource for more experienced case managers, particularly those whose training was less than adequate. |
| case management billing guidelines: The Case Manager's Training Manual David W. Plocher, Patricia L. Metzger, 2001 Stem Cell and Bone Marrow Transplantation |
| case management billing guidelines: The Management of Security Cooperation , 2015-08 |
| case management billing guidelines: The 2010 Solo and Small Firm Legal Technology Guide Sharon D. Nelson, John W. Simek, Michael C. Maschke, 2011-07-16 Computers -- Computer operating systems -- Monitors -- Computer peripherals -- Printers -- Scanners -- Servers -- Server operating systems -- Networking hardware -- Miscellaneous hardware -- Productivity software -- Security software -- Case management -- Billing software -- Litigation programs -- Document management -- Document assembly -- Collaboration -- Remote access -- Mobile security -- More about Macs -- Unified messaging and telecommunications -- Utilities -- The legal implications of social networking -- Paperless or paper LESS -- Tomorrow in legal tech. |
| case management billing guidelines: Acute and Chronic Wounds - E-Book Ruth Bryant, Denise Nix, 2006-07-05 Using a multidisciplinary approach, this all-inclusive resource provides clinicians with a strong knowledge base for understanding the complete spectrum of wound care, including the structure of the skin, its functions, types of skin damage, physiology of wound healing, and general principles of wound management. Seven new chapters cover Principles of Practice Development; Skin Care Needs of the Obese Patient; Foot and Nail Care; Facilitating Adaptation; Support Surfaces; Devices and Technology in Wound Care; and Reimbursement and Billing. Recent advances in disease etiology, diagnosis, and treatment are discussed in appropriate chapters and each chapter opens with a list of learning objectives and closes with review questions. Authored and contributed by respected experts in wound care management - members of Wound, Ostomy and Continence Nurses Society (WOCN) and Wound Healing Society (WHS). Risk assessment scales are included to assist with determining a patient's risk for developing a wound. Assessment tools are provided to assist the clinician with wound evaluation, care, and treatment. Patient compliance and guidance on how to identify and resolve issues of non-compliance are discussed in the new Facilitating Adaptation chapter. The multidisciplinary approach to wound care management is discussed in a single chapter and applied throughout the text to demonstrate how this approach works and why it is critical to successful patient outcomes. A wound care product formulary lists wound care products by category, usage guidelines (indications and precautions), and helpful hints is included to facilitate outcomes measurement and quality improvement. Algorithms demonstrate the critical steps for topical wound care management. Key information is highlighted in box or table format to enable the user to quickly focus on selected information. Clearly defined chapter objectives provide a focused guide to key elements within each chapter. A self-assessment exercise is included at the end of each chapter to provide a review of critical chapter concepts. Seven new chapters: The Multidisciplinary Team Approach to Wound Management; Skin Care Needs of the Obese Patient; Foot and Nail Care; Facilitating Adaptation; Support Surfaces; Devices and Technology in Wound Care; and Reimbursement and Billing. Revisions to every chapter reflect the most recent advances in disease etiology, diagnosis, and treatment. Updated content reflects the latest technologic advances and therapies to strengthen the clinician's knowledge base in available treatment options. Assessment tools to assist the clinician with evaluation, care, and treatment. Explanation of how to set up a practice and the principles of practice development. |
| case management billing guidelines: Nursing Case Management Elaine Cohen, Toni G. Cesta, 2004-08-26 This classic resource offers complete coverage of nursing case management - from theoretical background and historical perspective to practical applications and how the field is changing to meet the challenges of today's health care environment. It focuses on the implementation of various case management models used throughout the United States and abroad. Key topics include the impact of public policy on health care; understanding the effects of health care reimbursement and its application at the patient level; throughput and capacity management; the impact of the revenue cycle; compliance and regulatory issues; and principles needed to improve case manager-client interaction. This helpful resource is designed to help nurse case managers assess their organization's readiness for case management, prepare and implement a plan to achieve necessary improvements and evaluate the plan's success. Includes numerous proven case management models currently being used in institutions across the country Organized to take the nursing case manager on a journey from the historical development of nursing case management to the successful implementation of a case management program Offers detailed guidance for planning, implementing, and evaluating a case management program Outlines the planning process with information on key topics such as analysis of the organization, the role of the organization's members, selection criteria for new case managers, case management education, credentialing, and partnerships Features guidelines for implementing a case management program with information on ethical issues, technology, compliance, and regulatory issues Addresses the evaluation component of developing and implementing a case management program by presenting information on outcomes, research, documentation, continuous quality improvement, measuring cost effectiveness, care continuum, and evidence-based practice Presents acute care and community based models of case management Highlights the evolution of collaborative models of case management, addressing key elements of joint decision-making, shared accountability, and interdisciplinary systems of care Addresses health care delivery through case management and public policy by presenting current legislative issues and their affect on both health care reimbursement and the application of care at the patient level Presents the insights, experiences, and advice of nursing administrators who have researched and successfully implemented nursing case management programs in various facilities |
| case management billing guidelines: CDT 2021 American Dental Association, 2020-09-08 To find the most current and correct codes, dentists and their dental teams can trust CDT 2021: Current Dental Terminology, developed by the ADA, the official source for CDT codes. 2021 code changes include 28 new codes, 7 revised codes, and 4 deleted codes. CDT 2021 contains new codes for counseling for the control and prevention of adverse oral, behavioral, and systemic health effects associated with high-risk substance use, including vaping; medicament application for the prevention of caries; image captures done through teledentistry by a licensed practitioner to forward to another dentist for interpretation; testing to identify patients who may be infected with SARS-CoV-2 (aka COVID-19). CDT codes are developed by the ADA and are the only HIPAA-recognized code set for dentistry. CDT 2021 codes go into effect on January 1, 2021. -- American Dental Association |
| case management billing guidelines: The Coding Manager's Handbook Rose T. Dunn, 2010-03-12 Provides a comprehensive and detailed look at coding managers' and supervisors' responsibilities and explains how to: allocate resources and structure the coding function to maximize productivity; select, develop, retain, and motivate staff; and establish a coding quality review program to ensure accuracy and compliance. |
| case management billing guidelines: Health Care Finance and the Mechanics of Insurance and Reimbursement Michael K. Harrington, 2023-07 Health Care Finance and the Mechanics of Insurance and Reimbursement combines financial principles unique to the health care setting with the methods and process for reimbursement (including coding, reimbursement strategies, compliance, financial reporting, case mix index, and external auditing). It explains the revenue cycle, correlating it with regular management functions; and covers reimbursement from the initial point of care through claim submission and reconciliation. Updated throughout the Third Edition offers expanded material on financial statements; new and expanded Skilled Nursing Facility examples; and enhanced sections on PDPM, Practice Management for Primary Care and other Specialties, Clearinghouse Processes, Predictive Modeling (data mining), and more. Key Features: - Thoroughly covers the methods and process for reimbursement including coding, reimbursement strategies, compliance, financial reporting, case mix index, and external auditing - Prepares health administration and health information management students with the necessary tools to successfully transition from the classroom to the health care facility. - Addresses all the new characteristics of the accounting authorities that the health care administrator will have to deal with after the COVID-19 Pandemic. - Includes a full chapter on the ACA that addresses recent and anticipated future changes that could impact not only the patient but the various health care organizations that provide care in the inpatient and outpatient settings. |
| case management billing guidelines: DC: 0-5 , 2016-11-01 |
| case management billing guidelines: Fordney's Medical Insurance and Billing - E-Book Linda M. Smith, 2021-10-27 - NEW! Insights From The Field includes short interviews with insurance billing specialists who have experience in the field, providing a snapshot of their career paths and offering advice to the new student. - NEW! Scenario boxes help you apply concepts to real-world situations. - NEW! Quick Review sections summarize chapter content and also include review questions. - NEW! Discussion Points provide the opportunity for students and instructors to participate in interesting and open dialogues related to the chapter's content. - NEW! Expanded Health Care Facility Billing chapters are revised to provide the latest information impacting the insurance billing specialist working in a variety of healthcare facility settings. |
| case management billing guidelines: Clinician's Guide to Psychological Assessment and Testing John M. Spores, 2012-09-18 This nuts-and-bolts guide to conducting efficient and accurate psychological testing in clinical settings provides mental health professionals with experienced guidance in the entire process. It features a complete set of printed and electronic forms and templates for all aspects of assessment and testing, from the initial referral to the final report. It presents a standardized process of assessment, testing, interpretation, report-writing, and presenting feedback. Integral to the book is a review of psychological tests in seven key categories that most effectively address differential diagnostic dilemmas that clinicians are likely to encounter in practice. Numerous case examples illustrate the process in action. |
| case management billing guidelines: Amtrak management systemic problems require actions to improve efficiency, effectiveness, and accountability : report to the Chairman, Committee on Transportation and Infrastructure, House of Representatives. , |
| case management billing guidelines: A Guide to Managed Care Medicine William N. Tindall, 2000 Provides physicians, administrators, and other health professionals with information on managed care, from its history, forms and practices to detailed information on managed care contracting, physician compensation, monitoring, reporting, management, risk, productivity, and accountability. Annotati |
| case management billing guidelines: Insurance Handbook for the Medical Office Marilyn Fordney, 2013-01-01 A complete guide to insurance billing and coding, Insurance Handbook for the Medical Office, 13th Edition covers all the plans that are most commonly encountered in clinics and physicians' offices. Its emphasis on the role of the medical insurance specialist includes areas such as diagnostic coding, procedural coding, Medicare, HIPAA, and bill collection strategies. Learning to fill in the claim form accurately is made easier by the use of icons for different types of payers, lists of key abbreviations, and numerous practice exercises. This edition provides the latest on hot topics such as ICD-10, healthcare reform, the new CMS-1500 form, and electronic claims. Trusted for more than 30 years, this proven reference from Marilyn Fordney prepares you to succeed as a medical insurance professional in any outpatient setting. Emphasis on the business of running a medical office highlights the importance of the medical insurance specialist in filing clean claims, solving problems, and collecting overdue payments.Key terms and key abbreviations are defined and emphasized, reinforcing your understanding of new concepts and terminology.Detailed tables, boxes, and illustrations call out key points and main ideas.Unique! Color-coded icons clarify information, rules, and regulations for different payers.An Evolve companion website enhances learning with performance checklists, self-assessment quizzes, and the Student Software Challenge featuring cases for different payer types and an interactive CMS-1500 form to fill in.A workbook contains learning tips, practice exercises for key terms and abbreviations, review questions, study outlines, performance objectives, a chapter with practice tests, and critical thinking activities for hands-on experience with real-world cases. Available separately. Updated coverage of key health insurance topics includes HIPAA compliance, the HITECH Act, health reform of 2010, electronic health records, electronic claims, ICD-10, NUCC standards, Physician Quality Reporting System (PQRS) Incentive Program, Meaningful Use, and CPT 2013.Updated ICD-10 coding information prepares you for the October 2014 ICD-10 implementation date.Updated content on claim forms includes block-by-block explanations and examples for the new CMS-1500 Claim Form.Updated guidelines for the filing and submission of electronic claims include sample screenshots and prepare you for the future of the medical office. |
| case management billing guidelines: Community Treatment for Youth Barbara J. Burns, Kimberly Hoagwood, 2002-01-30 This outstanding textbook presents innovative interventions for youth with severe emotional and behavioral disorders. Community Treatment for Youth is designed to fill a gap between the knowledge base and clinical practice through its presentation of theory, practice parameters, training requirements, and research evidence. Featuring community-based and state-of-the-art services for youth with severe emotional and behavioral disorders and their families, this volume describes each intervention in depth, along with the supporting evidence for its utility. Most chapters present a single intervention as an alternative to institutional care. Shared characteristics of these interventions include delivery of services in the community (homes, schools, and neighborhoods) provided largely by parents and paraprofessional staff. The interventions are appropriate to use in any of the child human services sectors and have been developed in the field with real-world child and family clients. In addition, they offer a reduced cost in comparison to institutional care. Several chapters address diagnostic-specific psychosocial and psychopharmacological treatments, which are likely to be provided as adjunctive treatment in a clinical setting. Designed to update professionals in the field about effective services, Community Treatment for Youth will serve as a resource for academics, policymakers, practitioners, consumers, and researchers. |
| case management billing guidelines: Insurance Handbook for the Medical Office - E-Book Marilyn Fordney, 2014-08-27 A complete guide to insurance billing and coding, Insurance Handbook for the Medical Office, 13th Edition covers all the plans that are most commonly encountered in clinics and physicians’ offices. Its emphasis on the role of the medical insurance specialist includes areas such as diagnostic coding, procedural coding, Medicare, HIPAA, and bill collection strategies. Learning to fill in the claim form accurately is made easier by the use of icons for different types of payers, lists of key abbreviations, and numerous practice exercises. This edition provides the latest on hot topics such as ICD-10, healthcare reform, the new CMS-1500 form, and electronic claims. Trusted for more than 30 years, this proven reference from Marilyn Fordney prepares you to succeed as a medical insurance professional in any outpatient setting. Emphasis on the business of running a medical office highlights the importance of the medical insurance specialist in filing clean claims, solving problems, and collecting overdue payments. Key terms and key abbreviations are defined and emphasized, reinforcing your understanding of new concepts and terminology. Detailed tables, boxes, and illustrations call out key points and main ideas. Unique! Color-coded icons clarify information, rules, and regulations for different payers. An Evolve companion website enhances learning with performance checklists, self-assessment quizzes, and the Student Software Challenge featuring cases for different payer types and an interactive CMS-1500 form to fill in. A workbook contains learning tips, practice exercises for key terms and abbreviations, review questions, study outlines, performance objectives, a chapter with practice tests, and critical thinking activities for hands-on experience with real-world cases. Available separately. Updated coverage of key health insurance topics includes HIPAA compliance, the HITECH Act, health reform of 2010, electronic health records, electronic claims, ICD-10, NUCC standards, Physician Quality Reporting System (PQRS) Incentive Program, Meaningful Use, and CPT 2013. Updated ICD-10 coding information prepares you for the October 2014 ICD-10 implementation date. Updated content on claim forms includes block-by-block explanations and examples for the new CMS-1500 Claim Form. Updated guidelines for the filing and submission of electronic claims include sample screenshots and prepare you for the future of the medical office. |
| case management billing guidelines: The Essential Guide to Coding in Otolaryngology Seth M. Brown, Kimberley J. Pollock, Michael Setzen, Abtin Tabaee, 2021-09-07 The Essential Guide to Coding in Otolaryngology: Coding, Billing, and Practice Management, Second Edition is a comprehensive manual on how to properly and compliantly code for both surgical and non-surgical services. It is a practical guide for all otolaryngology providers in the United States, including physicians early in their career requiring a working knowledge of the basics, experienced providers looking to understand the latest updates with ICD-10-CM and CPT changes, related specialists (audiology, speech pathology, and physician extenders) providing otolaryngologic health care, and office administrative teams managing coding and billing. Included are sections on how to approach otolaryngology coding for all subspecialties in both the office and operating room. Foundational topics, such as understanding the CPT and ICD-10-CM systems, use of modifiers, managing claim submissions and appeals, legal implications for the provider, coding for physician extenders, and strategies to optimize billing, are presented by experts in the field. Focused on a practical approach to coding, billing, and practice management, this text is user-friendly and written for the practicing physician, audiologist, speech pathologist, physician extender, and coder. The income and integrity of a medical practice is tied to the effectiveness of coding and billing management. As profit margins are squeezed, the ability to optimize revenue by compliant coding is of the upmost importance. The Essential Guide to Coding in Otolaryngology: Coding, Billing, and Practice Management, Second Edition is vital not only for new physicians but for experienced otolaryngologists. New to the Second Edition: * Strategies for integrating revised guidelines for coding and documenting office visits * New and evolving office and surgical procedures, including Eustachian tube dilation and lateral nasal wall implants * Updated coding for endoscopic sinus surgery and sinus dilation * Billing for telehealth visits * Revision of all sub-specialty topics reflecting changes in coding and new technologies * New and revised audiologic diagnostic testing codes Key Features * All chapters written by practicing otolaryngologists, health care providers, practice managers, legal experts, and coding experts * Discussion of the foundations of coding, billing, and practice management as well as advanced and complex topics * Otolaryngology subspecialty-focused discussion of office-based and surgical coding * Tips on how to code correctly in controversial areas, including the use of unlisted codes * A robust index for easy reference |
| case management billing guidelines: Social Work Case Management Michael J. Holosko, 2017-01-30 Social Work Case Management: Case Studies From the Frontlines by Michael J. Holosko is an innovative book that equips readers with the knowledge and skills they need to be effective case management practitioners in a variety of health and human service organizations. A must-read for students and professionals in social work, this important work introduces a unique Task-Centered Case Management Model built around the unifying principles of the profession—person-in-environment, strengths-based work, and ecological perspective. Over twenty case studies by case managers and professionals offer innovative practice insights, illustrating the practice roles and responsibilities of today's case managers and the realities of conducting case management in today’s growing, exciting, and challenging field. |
| case management billing guidelines: EPSDT : a Guide for Educational Programs United States. Health Care Financing Administration, 1992 |
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