Medical Necessity, Diagnosis Coding & Reimbursement
Course Description:
This presentation will review the legal description of medical necessity as it pertains to reimbursement for healthcare services. It will explore the role that ICD-10-CM diagnosis codes play in this aspect of the reimbursement process, including examples and case scenarios.
We will explain the impact of ICD-10-CM diagnosis coding on the reimbursement process – on whether a claim gets approved, denied, or reduced. We will discuss the steps beneficial to obtaining optimal reimbursement for procedures, services, and treatments provided.
Having a claim denied for lack of medical necessity when you are working for a legitimate, honest provider is something that should not go unchallenged. We must always ensure that the documentation, and the ICD-10-CM diagnosis codes reported are aligned with payer requirements. We will discuss all these perspectives.
Learning Objectives:
- Build understanding of the role of diagnosis codes in reimbursement
- Examine physician documentation for rationales for ensuing procedures, services, and treatments
- Utilize resources to predict third-party requirements to prompt physician queries, as necessary
- Identify diagnosis coding changes for 2024
- Avoid delays in reimbursement due to invalid codes
- Understand how to apply the new codes and guidelines when applicable
- Know the tools to educate providers on the documentation needed to assign the appropriate codes
Areas Covered in the Session:
- The Definition of Medical Necessity used by Payers
- What ICD-10-CM Diagnosis Codes Report
- Identifying the Details in the Documentation
- The Legal Query Processes
- Investigating Payer Requirements
- Understanding Pre-requisites
- Medicare and Medical Necessity
- Live Q&A Session
Suggested Attendees:
- Administrators
- Managers
- Physicians
- Claims Adjusters
- Surgery Schedulers
- Caseworkers
- Nurses
- Medical Auditors
- Providers
- Reimbursement Staff
- Physician Office Practice Managers
- Medical Billing Professionals
- Medical Coding Professionals
- Revenue Cycle Managers
About the Presenter:
Dr. Shelley C. Safian, PhD, RHIA, CCS-P, has been teaching Health Care Administration, Health Information/Informatics Management, and Medical Billing and Coding, both onsite and online, for more than 20 years. She has a PhD in Health Care Administration and Masters in Organizational Management/Health Care Administration/Health Informatics.
In addition, she is the author of eight textbooks, including, “Let’s Code It!” 4th edition, which will be released by McGraw Hill in January 2024 and ”You Code It! 4th edition”, in January 2023. Safian is a Registered Health Information Administrator (RHIA), Health Care Information Security and Privacy Professional (HCISPP), Certified Coding Specialist (CCS-P), AAPC-Approved Instructor (COC, CPC-I).
Mary A. Johnson, MBA-HM-HI, is the Health Information Management Program Director at Central Carolina Technical College in Sumter, South Carolina. She is also an adjunct faculty member for Southern New Hampshire University and Bryan University. Her background includes corporate training using both on-campus and online platforms. Johnson has more than 15 years of teaching experience in medical coding and Health Information Management and specializes in the design and implementation of customized coding curricula. she is the co-author of four textbooks, including, “Let’s Code It!” 4th edition, which will be released by McGraw Hill in January 2024 and “You Code It! 4th edition”, in January 2023. Johnson received her Bachelor of Arts dual degree in Business Administration and Marketing from Columbia College and earned a Master of Business Administration with a dual focus in Healthcare Management and Health Informatics from New England College. Johnson is a Certified Professional Coder (CPC) credentialed through the American Academy of Professional Coders (AAPC).
Additional Information:
After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.
System Requirement:
- Internet Speed: Preferably above 1 MBPS
- Headset: Any decent headset and microphone which can be used to talk and hear clearly
Can’t Listen Live?
No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com
Snippet From Our Previous Session:
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