Question Details

MHA 612 WEEK 1 LEARNSCAPE  SIMULATION
Title	Critical Case for Billing and Coding 
Assessing Your Understanding 
What is the reason for the revenue reduction? 
A) It comes down to administrative errors in coding. Even though the use of injectable and infusible drugs was up over the last quarter, the procedures were not coded as such. 
B) It comes down to the charge master. We weren't assigning codes properly in the charge list for infusible and injectable drugs. 

How did you arrive at that conclusion? 
A) We ran the volumes report and then looked specifically at drug codes. 

B) We ran the revenue and usage summary, and then compared this year to last year to look at the quantity of items billed by charge code and payer. And then we broke out the volumes by inpatient and outpatient areas. 

Did you learn which stages of the revenue cycle are directly related to coding errors? 
 A)Well, that's true. Preparing claims and billing were the stages in which these mistakes were made. 

B) Yes, for sure. Preparing and submitting claims were the stages where mistakes were made. 


You know how coding relates to claim generation now? 
 A)Yes. Clinical information is assigned a diagnosis and procedure code, and that links to the DRG, or APC, and the insurers pay based on those codes, which are entered into a claim. 
B) Of course. HIPAA requires that we use both diagnosis and procedure codes. We use HCPCS codes for procedure reporting for outpatient services and also for physicians, and put those codes on claims. 

Do you understand how charge masters work? 
A) Indeed! Our charge master lists all the extra codes that Medicare requires for its outpatients. 

 B)Right. Our charge description master lists all the items for which the hospital has established prices. 


Did you learn how important claims editing is? 
A) So true. If the claims had been properly reviewed and edited, those mistakes would have been caught up front and we wouldn't have had this big loss. 
 B)Definitely. The right software is so important in claims editing. We're probably going to move to the cloud. 


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