Future Medical Cost Projections

Slides:



Advertisements
Similar presentations
Medical Insurance Chapter 18 ICBS 120.
Advertisements

PROCEDUREDIAGNOSIS CODE OVERVIEW. Participants will interpret basic medical codes and assess how to use them when conducting provider fraud investigations.
5/11/20151 ALL YOU EVER WANTED TO KNOW ABOUT BILLING & REIMBURSEMENT BUT WERE AFRAID TO ASK Presented by: Evelyn Alwine, RHIA CHDA Director Revenue Cycle.
Continuity Clinic Coding Patient Encounters EPISODE 1 Concepts.
University of Florida Health Science Center/Jacksonville 5th Annual National Congress on Health Care Compliance The Fundamentals of Coding for Non-Coders.
JEREMY S. MUSHER, MD, DFAPA PRESIDENT AND CEO MUSHER GROUP, LLC MUSHERGROUP.COM APA Advisor, AMA/Specialty Society RVS Update Committee (RUC) APA CPT Alternate.
Classification of Diseases
Calculating & Reporting Healthcare Statistics
INTRODUCTION TO ICD-9-CM
Workers Compensation Medical Fee Schedule Overview Paul Smallcomb Client Service Manager Medical Group Business Services.
Healthcare Common Procedure Coding System (HCPCS).
Billing and Coding for Health Services
Chapter 15 HOSPITAL INSURANCE.
Healthcare Common Procedure Coding System (HCPCS).
Using the Electronic Health Record for Reimbursement
ICD-10 Providers Information.  Expanded diagnosis and surgical procedure code sets to be much more specific  Expanded field format for ICD-10 codes.
Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
Copyright ©2012 Delmar, Cengage Learning. All rights reserved. Chapter 15 Procedural and Diagnostic Coding.
Presented By: Lenora Ballard and Robin Lewis. Agenda  2016 Policy Updates, Guidelines and Highlights  New Web Portal  Maximizing Incentive Opportunities.
Basic Practice Management Harald Lausen, DO, MA FCM Clerkship SIU School of Medicine.
HEALTH AND LIFE INSURANCE UNIT 7: CHAPTER 15 HEALTH INSURANCE Basic Coverages –H–Hospitalization Room and board, nursing care, medical supplies Use of.
Robyn Korn, MBA, RHIA, CPHQ HS225- Week 8 Overview of ICD-9-CM.
HEALTH INFORMATICS HEALTH SCIENCE II 1. JOB DUTIES OF HIM: COLLECT, ANALYZE, STORE INFORMATION (NOW DONE ELECTRONICALLY) CODING BILLING QUALITY ASSURANCE.
1.03 Healthcare Finances.
HCPCS Level II National Coding System
The Pharmacy Technician 4E
Clinical Terminology and One Touch Coding for EPIC or Other EHR
Future Medical Cost Projections
Basic Practice Management & Quality Improvement
Basics of Healthcare Financing and Reimbursement
EHR Coding and Reimbursement
WHAT IS THE PURPOSE OF ICD CODING?
Future Medical Cost Projections
Clinical Medical Assisting
Basic Concepts of Coding and Insurance
CHAPTER 33 INFORMATION AND ADMINISTRATION CAREERS Lesson 2
1.03 Healthcare Finances.
Proposed Medicaid Hospital Outpatient Prospective Payment System
Future Medical Cost Projections
Reimbursement Nutr 564: Summer 2002.
Insurance.
Chapter 14: Health Information and Administration
1.03 Healthcare Finances.
Disclaimer This presentation is intended only for use by Tulane University faculty, staff, and students. No copy or use of this presentation should occur.
Future Medical Cost Projections
Patient Medical Records
Future Medical Cost Projections
Using the Electronic Health Record for Reimbursement
Mary Jo Bowie MS, BS, AAS, RHIA, RHIT
Medicaid 101 Chiropractic Services
1.03 Healthcare Finances.
Billing and Coding for Health Services
Future Medical Cost Projections
1.03 Healthcare Finances.
Reporting, Coding and Billing Just the facts and where to find them
Mary Jo Bowie MS, BS, AAS, RHIA, RHIT
Comprehensive Medical Assisting, 3rd Ed Unit Three: Managing the Finances in the Practice Chapter 15 – Outpatient Procedural Coding.
1.03 Healthcare Finances.
Comprehensive Medical Assisting, 3rd Ed Unit Three: Managing the Finances in the Practice Chapter 14 - Diagnostic Coding.
Vital Protection Underwritten by: LifeShield National Insurance Co.
For Patients: Frequently Asked Questions
Ametros Overview.
For Patients: Frequently Asked Questions
Chapter 24: Health Information and Administration
Chapter 17 Medical Insurance.
Medical Insurance Coding
1.03 Healthcare Finances.
1.03 Healthcare Finances.
How Physicians Get Paid: It's as Easy as: CMS, RVUs, ICD-10, and CPT
Presentation transcript:

Future Medical Cost Projections Module 2 Common Factors in Cost Projecting

Common Factors in Cost Projecting Overview Discusses common factors in calculating future medical cost projections Objectives Be able to explain difference between rated and chronological age life expectancy Be able to discuss various types of fee schedules Be able to define various coding acronyms Be able to list standard treatment categories Be able to provide overview of case management protocol Copyright InSitu Academy

Copyright InSitu Academy Factors Life expectancy Fee schedules Coding Copyright InSitu Academy

Copyright InSitu Academy Life Expectancy Defines remaining years in life Chronological age: based on date of birth Rated age: based on medical condition and co-morbidities, calculated and documented by insurance actuary State statutes: most states have a code of law addressing life expectancy CDC mortality tables: tallied in male, female, total population, race, updated about every 1-2 years Copyright InSitu Academy

Copyright InSitu Academy Fee Schedules Worker’s Compensation Usual and customary Medicare Medicaid Billed rate Paid rate Collateral source rule Medication Copyright InSitu Academy

Worker’s Compensation Each state has its own fee schedule Some states have regional fee schedules Some are based on a modifier of the Medicare fee schedule Not always updated annually Book or on-line format, not always both WC commissions offer very little guidance or support Used in MSA cost projections Copyright InSitu Academy

Copyright InSitu Academy Usual and Customary Used in personal injury cases Worker’s compensation attorneys sometimes want both charts: state fee schedule and usual/customary Physician’s Fee and Coding: common resource/reference High, low, modifiers Updated annually Copyright InSitu Academy

Copyright InSitu Academy Medicare Cases involving Medicare beneficiaries Used in post-settlement allocations Federal and regional guidelines Many exclusions for coverage Copyright InSitu Academy

Copyright InSitu Academy Medicaid Used for Medicaid recipients State specific guidelines Rarely encountered in our work Copyright InSitu Academy

Copyright InSitu Academy Billed rate All providers and facilities have a billed rate Also called published rate, full retail pricing Contracts based on reduction of billed rate Copyright InSitu Academy

Copyright InSitu Academy Paid rate Amount actually paid Differs from billed rate Cash rate for uninsured Contracted rate Confidential Non-transparent Copyright InSitu Academy

Copyright InSitu Academy Medication Many ways to cost out drugs Average wholesale pricing Uses Redbook as reference Generic pricing Used in our calculations unless contraindicated Brand name pricing Discount sources pricing Goodrx.com/CVS often used in cost projections and life care plans Compounded drugs No reliable reference Costs vary tremendously Copyright InSitu Academy

Copyright InSitu Academy Coding CPT codes: current procedural terminology: a coding system for medical procedures that allows for comparability in pricing, billing, and utilization review DRG codes: diagnosis-related group is a system to classify hospital cases ICD-10: The international Classification of Diseases, Tenth Edition, is a system of diagnosis codes and other codes that U.S. healthcare providers are now using Lots of books resources on coding, certification as a Coder available Copyright InSitu Academy

Copyright InSitu Academy Standard of Care Future medical cost projections include these categories Diagnostics Laboratory Physician visits Therapy Equipment Medications Injections Surgery Copyright InSitu Academy

Case Management Protocol Replacement scheduling Supplies and durable medical equipment Needs assessment: evaluations Copyright InSitu Academy

Copyright InSitu Academy Methodology Consistent approach Medical records review Client interview Billing records Other sources, not commonly available Depositions Physician conferences Pay-out history School records Copyright InSitu Academy

Copyright InSitu Academy Homework Download latest version of CDC (National Vital Statistics) life expectancy or mortality tables Research life expectancy chart for your state, plus one adjacent state, print and retain in records Calculate your life expectancy using all 3 charts Research state worker’s compensation fee schedule and if online version available, find CPT code 99213 (typically under E/M services) and determine cost Using online research (google), find CPT code for x-ray shoulder Copyright InSitu Academy

Copyright InSitu Academy Contact Information info@insitutraining.com Copyright InSitu Academy