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Results for “Current Procedural Terminology”

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At least 505 records · Page 28Linked to original sources
PubMed2005

Union Health Service celebrates 50th year managing capitated patients.

Union Health Services is celebrating its 50th year managing capitated patients. One measure of its success is the staff model HMO's ability to hold down premium hikes to 3.4% compared with the national average of 11.5%. Read about how the Chicago-based non-profit does it.

Capitation Fee↗
PubMedDate not supplied

PET coding.

Explore the source record for details and available documents.

Aged↗
PubMed2005

Infusions.

Explore the source record for details and available documents.

Current Procedural Terminology↗
PubMed2005

Coding for new technology.

New procedures and new technology often outpace the development of medical codes to report these services to the insurance payors. Although unlisted procedure codes are not the first choice for reimbursement, it is essential that services be reported with only the code that accurately describes the procedure. For new equipment and techniques, this may result in an increased need for preauthorizing, reporting an unlisted procedure code, and ensuring that complete documentation accompany the claim. Practices should educate the insurance community where necessary to ensure that everyone is working toward the same goal: the best patient care possible.

Current Procedural Terminology↗
PubMed2005

Carotid stenting.

Coding personnel should be aware of the new CPT guidelines for reporting carotid and vertebral stent placement. Payors' billing requirements for these procedures vary, and it is important to determine before billing whether the payor will accept the applicable CPT category I or III code or whether an unlisted code must be reported. Coding guidancefor these procedures will likely continue to evolve in thenear future.

Carotid Stenosis↗
PubMed2005

Benefiting from the government CERT audits.

In order to minimize the risk of submitting improper or false claims, one important component of a compliance program is performing medical chart audits to make certain that all of the essential elements of the billed codes are present in the physician's documentation. The federal government has a program know as the Comprehensive Error Rate Testing (CERT) program which is responsible for auditing the frequency of errors committed by 1) Medicare providers and 2) Medicare carriers and then publishing those results in a report. The CERT report can be a useful guide for auditing charts because it identifies areas that have been particularly problematic and are more likely to be closely scrutinized by governmental auditors.

Current Procedural Terminology↗
PubMed2005

Prospective, blinded evaluation of accuracy of operative reports dictated by surgical residents.

Incomplete or inaccurate operative notes result in delayed, reduced, or denied reimbursement. Deficient reports may be more common when dictated by the surgical residents. We performed a blinded study to assess the accuracy of residents' dictations and their effect on the appropriate level of coding for reimbursement. A prospective, blinded study was performed comparing operative reports dictated by senior surgical residents (postgraduate years 3, 4, and 5) to reports dictated by attending surgeons. All residents had previously undergone group instruction on the importance and structure of operative notes. The trainees were blinded to the fact that the attending surgeons were dictating the operative reports on a separate dictation system. The dictations were analyzed by faculty reimbursement billing personnel for accuracy and completeness. Fifty operative reports of general surgical procedures dictated by both surgical residents and attending physicians were reviewed. A total of 97 CPT codes were used to report services rendered. Residents' dictations resulted in incorrect coding in 14 cases (28% error rate). The types of inaccuracies were a completely missed procedure (4) and insufficient documentation for an appropriate CPT code and/or modifier (10). All deficiencies occurred in complex, multicode, and/or laparoscopic cases. Sixty-seven per cent of late dictations were incomplete. The financial analysis revealed that deficiencies in resident dictations would have reduced the reimbursement by $18,200 (9.7%). For cases with deficient dictations, 29.5 per cent of charges would have been missed, delayed, or denied if the resident-dictated note was used to justify charges. Operative reports dictated by surgical residents are often incomplete or inaccurate, likely leading to reduced or delayed reimbursement. Dictations of complex, multicode, or laparoscopic surgeries, especially if delayed beyond 24 hours, are likely to contain significant deficiencies that affect billing. Attending surgeons may be better equipped to dictate complex cases. Formal housestaff education, mentorship by the attending faculty, and ongoing quality control may be paramount to minimize documentation errors to ensure appropriate coding for the services rendered.

Current Procedural Terminology↗