NHA Billing & Coding Study Guide

Must be included when billing an insurance company: - DOS, POS, TOS, and dx or DX DOS - Date of Service POS - Place of service TOS - type of service DX or dx - diagnosis HIPAA - under what rule mays use patients Protected Health Information (PHI) with out specific authorization for treatment, payment, and operation purposes (TPO). T in TPO? - treatment P in TPO? - Payment O in TPO? - Operations What does (T)reatment in TPO mean? - primarily for the purpose of discussion of the patients case with other providers What does (P)ayment in TPO mean? - where providers submit claims on behalf of patients What does (O)perations in TPO mean? - for purposes such as staff training and quality improvement Employer Liability - physicians are legally responsible for their own conduct and any actions of their employees. Employee Liability - "errors and omissions insurance" a protection against a loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim Let the master answer - means an employee can be sued and brought to trial Medical Record - : documentation on the patients social and medical history, family history, physical examination findings, progress notes, radiology and lab results, consultation reports and correspondence to patient Reason 1 for Documentation of Pt Records - avoiding denied payments by insurance carriers investigating the medical necessity of services Reason 2 for Documentation of Pt Records - enforcement of record keeping rules by insurance carriers requiring accurate documentation that supports procedure and diagnostic codes Reason 2 for Documenting of Pt Records - Subpoena of medical records by state investigators of the court review Reason 4 for Documenting of Pt Records - Defense of a professional liability claim Indefinitely - a M.D. must keep living Pt records for 5 years - a MD must keep deceased Pt records for pain - -algia blood condition - -emia inflammation - -itis enlargement - -megaly measure - -meter tumor, mass - -oma abnormal condition - -osis disease condition - -pathy bursting forth of bloos - -rrhagia discharge or flow - -rrhea hardening - -sclerosis to view - -scopy surgical puncture - -centesis removal - -ectomy record - -gram