Cristina Thibeault Week 2 ProjectCOLLAPSE

Centers for Medicare and Medicaid Services also known as CMS and use to be known as Health Care Financing Administration which was known as HCFA. I hear about CMS at my job all the time, so CMS payment systems are very familiar to me. CMS is an agency within the Federal Department of health and human services. (Green, M. & Rowell, J., p. 729) What this agency does it administered a few different kinds of health care programs. Some of these programs require reimbursement for services that were provided. Like at my job, if a patient got a colonoscopy or an endoscopy, some require reimbursement, according to the health plans that fall under this. The federal agency uses the PPS system, known as Prospective Payment System, which is a payment of some sort, made which is based on predetermined or fix amounts, no what services were provided, anywhere from a huge service to the smallest.  Some of the health plans that fall under this, is CHAMPVA, Indian Health Services, Medicaid, Medicare, Tricare and Workers comp.

Now to talk about ICD codes. ICD stands for the International Classification of Diseases. This coding is used to classify mortality data from death certificates. (Green, M. & Rowell, J., p 156)

This is coding system for diagnoses, conditions, symptoms and more. These codes are all documents on procedure reports, office visits, etc. It is very imperative that you don’t mess up on this kind of coding because it can reduce the amount of denials and claim submission better.

ICD-10 codes are more specific then ICD-9. Instead of using one standard coding for a polyp you find on patient, now you have to use an ICD-10 code that specifies exact conditions.

CPT stands for Current Procedural Terminology.  This is used to report any medical, surgical and diagnostic procedures performed by the provider.

HCPCS, known as healthcare common procedure coding system is a set of health care procedure codes based on AMS. HCPCS works hand in hand with CPT and can get a little confusing.  HCPCS includes three separate levels of codes: Level I, Level II, Level III. CPT fall under level 1.

WC:397

Reference:

Inc., H. (2018, November 1). Note similarities and differences between HCPCS, CPT® codes – www.hcpro.com. Retrieved from http://www.hcpro.com/HIM-284009-8160/Note-similarities-and-differences-between-HCPCS-CPT-codes.html

Green, M. & Rowell, J. (2013).  Understanding health insurance: A guide to billing and reimbursement. Clifton Park, NY: Delmar, Cengage Learning.