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2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

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Unrelated Procedures or Visits leading up to the “Pre-Operative” Period

Scenario:
A member is inpt., provider is billing code 99232-24 (DOS 01-28-19) mod. 24 as member is still post-operative of another 90-day procedure…

Now day after (01-29-19) provider billed 99232-24-57 as they are seeing the member in post-op but also made same day decision for another 90-day procedure (61510-58).

How should the 01-28-19 DOS be billed as it is the day prior to decision of the major surgery and provider is indicating unrelated and decision was made the next day/same day 01-29-19?

01-28-19 99232-24 denied because the visit was billed by the same provider within the 61510’s pre-operative period.
01-29-19 99232-24-57
01-29-19 61510-58

Medical Billing and Coding Forum

30th anniversary celebration: Leading through fear

30th anniversary celebration

Follow your instincts

by Patty T. Sheridan, MBA, RHIA, FAHIMA

When I look back on 30 years of involvement with HIM, it’s hard to believe that I was also passionate about another profession at one time. But I actually came to my career as a coder by way of my associate’s degree in veterinary science. As I explored my options to pursue a bachelor’s degree, my veterinary colleagues suggested I speak with a career counselor at a nearby college, and the counselor helped me to connect the dots between my personal strengths and aptitudes. My love of medicine, science, and information became evident.

I weighed out the pros and cons of a career in veterinary science and one in medical records. This is how I came to realize that I wanted a career that built upon my professional interests in healthcare and information management. My love of animals has translated to my personal life, so I have realized the best of both worlds!

 

A trifecta of HIM advantages

When I began pursuing my degree back in the mid-80s, we didn’t have a choice to join AHIMA. It was expected. We were expected to join, volunteer, and be fully engaged in our profession, even as students. As I became exposed to more aspects of the profession, I realized there were three critical advantages provided by AHIMA.

First, building a network of professionals would help me advance my career and provide mentors for the road ahead. Second, I had access to just-in-time information regarding my profession as part of working on committees addressing HIM practice issues. But more than anything, being actively involved in HIM helped me grow and evolve as a professional, as I was constantly pushed beyond my comfort zone in many areas related to management and leadership.

HIM, like the healthcare industry as a whole, has had to adapt to changes and trends in the world around us. I love that HIM is constantly evolving to respond to the needs of healthcare. There are specific points in our history when change has been particularly marked, and the current environment ranks among the most exciting and dynamic time of change.

A foundation of relationships

The value of networking was evident to me early on. However, I wish I had realized the value of forming deeper professional relationships when I was younger. A strong relationship foundation in the workplace leads to good things. Collaborating and asking for help gives you the skills needed for managing anxious situations, getting past conflicts, doing meaningful work with others, and improving your own outcomes. Not only are peer-to-peer relationships vital, but so are cross-departmental relationships, as well as an ability to work closely with managers at all levels.

The foundation of a good relationship is built on honest conversations, even when difficult, because that is how you create mutual respect and get things done. I do wish I had learned earlier on the importance of collaboration, rather than trying to solve problems on my own. The power of a group of experts, all giving their very best ideas to resolve a problem, can change the trajectory of a healthcare system in an environment where change can be difficult.

 

Getting ahead of the curve

One accomplishment I can say I’m most proud of is my work as an early adopter of technology in the late 80s and early 90s, which resulted in solving problems related to health information access and exchange. As an early pioneer working on document imaging solutions, I was in a unique position to make meaningful contributions to my workplace and to healthcare reform activities. To this day, I look for innovative ways to apply technology in my role?it can be incredibly powerful.

I’ve also experienced great satisfaction from my work as a coding supervisor in a large healthcare system. DRGs were just being implemented when I took on a supervisory role in my late 20s. I had the opportunity at a young age to build a collaborative effort among coders, physicians, and C-suite executives to ensure successful DRG implementation. This experience led me to appreciate leadership on a deeper level and realize that leadership is more than just a line on an organizational chart. I have come to think of leadership as something anyone can exercise regardless of their title. We are all responsible for exercising leadership and doing our job to the best of our abilities, no matter what our title is.

Adaptive change

As HIMB celebrates 30 years of HIM, it’s obvious that much about HIM has changed. But the guiding principles of information management and the importance of following my instincts and adapting have remained constant. Given how quickly change is happening, it has become less important to try and predict what will happen in the future and instead remain flexible when change occurs.

As HIM professionals, we can model what it looks like to break through silos, improve data quality, innovate HIM processes, encourage patient engagement, and remove barriers to accessing and sharing information. Every day, I ask myself, what do I need to do today to be a responsible leader? It’s a question that always helps me to stay focused and keep moving forward.

 

Editor’s note

Patty Thierry Sheridan, MBA, RHIA, FAHIMA, is the senior vice president of HIM services for CIOX Health in Alpharetta, Georgia. She is a trailblazer who is passionate about health information management (HIM), leadership, and volunteerism. She has a track record of leveraging HIM, business, and leadership experiences to create innovative HIM solutions and develop successful leaders. Prior to joining CIOX Health, she was the president of Care Communications, Inc., and has also held senior roles at the American Health Information Management Association (AHIMA) and HIM roles in acute care teaching facilities.

She is the recipient of AHIMA’s Distinguished Member Award and the Illinois Health Information Management Association’s Professional Achievement award. She has published research articles and authors the column "Hands-on Help" in the online magazine, Advance for Health Information Professionals and Executive Insight. She is a frequent speaker on the topics of health information management and leadership. She is the Chair of the Resurrection University Board of Directors for the College of Nursing and College of Allied Health, and a member of the AHIMA Foundation Research Network.

 

Leading through fear

It is often said that people fear public speaking even more than they fear death. I am one of those people. When I was asked to speak early in my career, even just at a meeting, I would literally get sick to my stomach. My heart would race and I would get nauseated. I understood, though, that if I failed to conquer this fear, it would limit my career growth. I wanted to make a difference, and that’s hard to do if you’re silent!

Over the years, my fear got worse, not better. I enjoyed hearing others and learning from them, and I know my colleagues wanted to hear my ideas as well. So, to overcome my fear, I looked for opportunities to speak at workplace meetings and at conferences. Throughout this journey, many people encouraged and coached me, including professional presenters. I learned how to regulate my breathing and speak without notes. I realized the importance of not hiding behind a podium so I could connect with my audience.

Over time, I trained myself to speak confidently. I still get nervous to this day before getting up in front of a group. However, once I begin talking, my fears dissipate. This has proven to be a valuable leadership lesson for me. I overcome obstacles by pushing through them rather than avoiding them, and look for help from strangers and mentors when I need it.

HCPro.com – HIM Briefings

failure to address substance abuse, leading to fines

Hi
Some of my providers read this article:

http://c-hit.org/2018/03/20/med-boar…haven-doctors/

And they are wondering What is meant when the article states that the "board reprimanded and fined a West Haven doctor $ 1,000 for failing to address a patient’s weight loss and substance abuse in 2016." They are wondering what exactly he “failed to address” or document in his notes that led to this. In particular, "his failure to address substance abuse in 2016”.

How exactly do you address that in your providers’ documentation? For patients with known active history of IV drug/heroin abuse, aside from documenting that the provider encouraged the patient to go to rehab, is there anything else that needs to be done to prevent being hit with a similar fine?

thanks!

Medical Billing and Coding Forum

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At present the demand for medical billing in Arizona is quite high and the prospects of increase in demand for medical billing and coding specialists is bright. Therefore the medical billing and coding Arizona companies have to be equipped to cater to the medical sector which is quite popular and well established in Arizona due to the age and nature of citizens residing in Arizona.

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Arizona holds good and bright prospects for those who are looking to make a career in medical billing and coding field. There are many outsourcing corporations like ours, equipped to train individuals in medical billing and coding program. We train students in real time situations using real medical billing data. Our faculty comprises of experienced medical billing and coding specialists who not only train students but who service our clients.
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Looking for HCC Team leading position in Port St. Lucie area

Tehmina S. Irfan, CPC_________________________
1435 N.W. 22nd Ave, Delray Beach, Florida 33445, E-Mail: [email protected] Phone: (561) 843-8978

CAREER SUMMARY

• MRA Dept. team leader
• Train billers/coders, general staff, and PCPs for documentation, E&M, MRA, HEDIS, & PQRS (for original Medicare) guidelines
• Continue EHR experience: Practice Fusion, MD 2000, Soap Notes, E-clinical works, Kareo, Medisoft, GPRO, & Athena
• Possess the combination of years of organizational and administrative skills coupled with expertise in medical coding and instructing physicians and their staffs in compliance.
• Earned various certifications including in A+, CPC, and ICD-10 Proficiency certifications (currently pursuing CPMA) which make for a valuable asset to every team.
• Contribute to the workplace major strengths: critical thinking skills, problem solving, maintaining target goals and completing projects while accommodating path adjustments, a determined thirst for knowledge, excellent interpersonal skills and customer service.
• Master essential communication and technical areas while possessing and an eye for detail.
• Embrace the challenge of data integrity through planning, maintenance, and employee training, which is (Humana) and has been relevant throughout my professional career.
• Perform secretarial duties along with mentoring new members as the Secretary of AAPC Palm Beach Chapter

Work History

Medical Specialists of the Palm Beaches, Inc.
HCC CODER/Auditor/Educator
January ‘9th – Current

• Reviewed medical records and practice management code data to determine if the medical record is complete, accurate, and in support of individual patient risk adjustment score accuracy.
• Sequenced and assigning codes from ICD-10 methodology based on the code which most accurately describes each documented diagnoses.
• Educated providers and their practice staff in Medicare coding guidelines, focusing on revenue enhancement opportunities.
• Collaborated with other departments to develop plans and materials that support education and system changes to meet practice and revenue goals.

Humana
MRA Coder/Auditor
March ‘15 – December 21st 2016

• Reviewed medical record information to identify all appropriate coding based on CMS HCC categories.
• Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
• Provided support, education, and training related to the quality of documentation, level of service, and diagnostic coding consistent with established coding guidelines and standards.
• Extended real time support and coordination with Primary Care Providers and Care Coordinators for MRA coding, HEDIS, and STARS.
• Coordinated with clinical leadership in the development of provider training plans and for active support in the training process.
• Organized and schedule periodic training as indicated from chart review results, and/or as requested by medical leadership or CBO management.
• Monitored coding modifications to ensure that the most current information is available.
• Facilitated coding support to CBO as requested.

Outcomes Health Information Solutions
December ‘14- May ‘15: Remote HCC Coder/Auditor
• Auditing/Coding charts for Compliance/MRA

TSI Billing & Coding of USA
February ‘12- /current: Medical Billing / Internal Auditing services
• Medical Billing and Auditing records for local Physicians

Primus Health Network Inc., LLC
September ‘12- November ‘14: Coding Specialist/Auditor
• Audited charts for MRA, HEDIS, & PQRS for G-PRO
• Trained physicians & staff in documentation compliance
• Assisted physician & staff capturing HEDIS measures
• Supervised billing staff with the coding process

American Academy of Professional Coders (AAPC)
January ’17 – Current: Secretary of Palm Beach Chapter
• Perform secretarial duties along with mentoring new members
March ‘12- January ’13: New Member Development Officer of Palm Beach Chapter
• Performed duties as a mentor

Dr. Saleem A. Haq, M.D
November ‘98 – April ‘12: Office Manager/ Medical Biller & Coder
• Managed all office matters
• Medical billing and coding for all types of payers
• Referral Coordinator
• MD credentialing
• Assisted in hiring process
• Maintained all office computer systems
• , maintenance, and employee training, which is (Humana) and has been relevant throughout my professional career.

PROFESSIONAL SKILLS/ PREVIOUS JOB RESPONSIBILITIES
• Knowledge of Share point and clouds
• Auditing Humana, BCBS, United HealthCare, and Medicare, among other major insurance companies
• Earned certification from FHIMA for inpatient coding (Advanced ICD-10- CM & ICD-10 PCS)
• In depth knowledge of coding guidelines (ICD-9-CM, ICD-10-CM & PCS, CPT, and HCPCS), CMS regulations, state provider licensure and certification requirements, commercial insurance clinical and reimbursement policies, and audit and appeal techniques
• Flexible, detail-oriented ability to be a positive influence on others, skilled at working independently, willingness to take ownership of responsibilities, quality conscious, dependable, and ability to adapt well to change
• Proficiency with Microsoft Office Suite, including Word/Power Point/Excel
• Strong interpersonal and presentation skills
• Proficient in written and oral communication skills at all corporate levels
• Multilingual: English, Hindi, and Urdu
• 18+ years of billing and coding experience in outpatient settings
• Member of American Health Information Management Association (AHIMA) & American Academy of Professional Coders (AAPC)

EDUCATION/TRAINING
• CPMA (in progress)
• ICD-10 Proficiency Certification
• CPC
• 18+ years of coding and auditing experience in HCC & HEDIS and outpatient office setting
• BA in general studies

CONTINUING EDUCATION
• MRA education & Training Disease Specific
• 2017 CPT updates
• 2017 Professional Development for Officers
• Humana-based courses/certifications (a variety of skills)
• Clinical Documentation Improvement
• Experienced in coding/auditing E & M, HEDIS, MRA
• Data Breach Compliance and Response: “Preparing for the First 24 Hours of a Data Breach and Beyond”
• “How To Find Coding Info You Didn’t Know You Needed To Know”
• “Pay for Performance: Putting the Pieces Together”
• “CDI, Coding and Your Physician Relationship…Be the Pack Leader”
• “ICD-10 The Good The Bad & The Ugly”
• “E & M: Navigating the Real World Record”

References: Upon Request

Medical Billing and Coding Forum

Leading Through Change? Start with Why.

Leading Through Healthcare Change

Leading Through Healthcare Change

If you change the way you look at things, the things you look at change.  – Wayne Dyer

Change in healthcare is taking place at an incredible pace, and indeed might be our only constant.

In my work as a nurse consultant, I am fortunate to see once struggling teams thrive through change and embrace a new mindset : Serving families with compassionate, efficient, patient-focused and evidence-based care.

I was talking with a practice manager not long ago about meetings she held with nursing staff to discuss a new direction the organization was taking. A young medical assistant stood up during one of the information meetings and said – “before you start telling us about what we will be doing – can you please explain why?” We both agreed her question got to the heart of the matter:

People won’t buy into what you do without knowing why you do it.

With that in mind, here are 3 strategies to consider when leading the change process:

Set an example

As a leader in your practice, others turn to you for direction in business needs, behavior, ethics, and standards. If others in your business are to change, you need to set an example. One of my early career mentors once told me during a coaching session, “A leader is one who knows the way, goes the way, and shows the way.”

Walk around and talk to people.

Today’s leaders manage a team better through face-to-face interactions, while learning more about challenges on an individual basis. One of the most effective and well respected practice managers I know made it a weekly habit of walking through every department of the three-story practice. Not just buzzing through. He took the time to meet every single person who worked at the practice. Through his ‘walking rounds’, he built his reputation as an interested and trusted manager.

Be genuine.

To be a leader of change, it’s critical to be honest in your interactions with other people. You don’t have to open yourself up like a book, but being a leader also doesn’t mean you need to hide your emotions. Just let people get to know you. Doing so allows you to build trust and rapport.

Be transparent.

Target every group within your practice regarding your campaign for change, explaining to each why change is necessary. For example, the practice Board of Directors may be curious about the long-term effects of the change. Or, your staff may want to know how they will personally be affected by proposed changes.

Communicate, communicate, communicate.

Keep your team members up-to-date on what’s happening…before, during, and after the change. Don’t assume everyone knows. It may help to set up a formal way of communicating…something as simple as a succinct weekly email update. By keeping everyone informed, you reduce the chances of low productivity and low morale.

Change can be hard, but altering the pace of change in our environments is not likely to be a leadership option now or in the future. What is within our control is how we personally respond to change.

How have you been able to help your team cope effectively with change? I’d love to hear your story!

— This post Leading Through Change? Start with Why. was written by Carol Bush and first appeared on Capture Billing. Capture Billing is a medical billing company helping medical practices get their insurance claims paid faster, easier and with less stress allowing doctors to focus on their patients.

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