June 15, 2015
Clinical IT and Financial IT
With so many changes coming about the health care field it is hard to keep up with all the new terminology and systems being put into place. To become more familiar with some of the newer medical systems and financial billing system terminology in the health care field.
The first abbreviation is CPT. CPT stands for Current Procedural Terminology. This coding system was developed by the American Medical Association. The system was setup as a system to correlate a patient’s diagnosis codes and codes that insurance companies use in order to pay for the services that providers provide (CPT, 2009). Each CPT code represents a particular service charged by the physician to the insurance provider. These codes are sent to insurance companies from billing departments in every health organization. CPT is important as it provides health organizations with codes that will allow them to be paid by insurance companies for their services.
The abbreviation CMS-1500 is the abbreviation used for the professional health care insurance form used in the U.S. It was previously known as the HCFA-1500 claim form. The CMS-1500 form is the claim insurance form for people who have Medicare and Medicaid health insurance. This form is required to be completed the Centers for Medicare & Medicaid Services of the U.S. Department of Health & Human Services in order for providers to get paid (CMS-1500, 2012). This form is an important tool for non-institutional medical provider and suppliers as well to be able to bill Medicare carriers and medical equipment carriers. “This occurs when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claim” (CMS-1500, 2012).
CMS is the abbreviation for Centers for Medicare and Medicaid Services. This agency was formerly known as the Health Care Financing Administration (CMS, 2002). This is the Agency that oversees administrating insurance coverage to those who qualify for state and federal medical benefits. CMS is responsible for providing the reimbursement for health care providers who provided services. CMS is also responsible for taking charge of providing advancements in the health IT world as well. This includes “the implementation of electronic health record (EHR) incentive programs, a definition for the meaningful use of certified EHR technology, the drafting of standards for the certification of EHR technology and the updating of health information privacy and security regulations under HIPAA” (Rouse, 2015).
The UB-04 is a form that was developed by the National Uniformed Billing Committee. This is a uniform provider claim form that is used for appropriate billing of multiple third party payers. The UB-04 is the current version of the paper bill form that is used by institutional care providers and contains information divisions acknowledged as necessary for claims processing in the paper environment (UB-04, 2007).
. ICD-9 stands for International Classification of Diseases, Ninth Revision. ICD- 9 is a coding system. A medical provider uses the ICD-9 codes any time they receive a patient. The codes are used when a physician diagnoses a patient. Medical coders and billers assign the appropriate code to the diagnoses for medical history purposes and billing of insurances (Joseph, 2010). The ICD-9 is extremely important to the health institute as it improves the billing system to insurance companies and these companies are familiar with the codes. This allows quicker turn around in payments to the providers.
DRG stands Diagnosis-Related Group. The DRG is a managed method of classifying patients. THE DRG classifies the patient by their average span of hospital stay, diagnosis, and the treatment that they received while under care at the hospital. These results is used to determine how much