(wow) Words Of Wonders Level 891 Answers – Listen to recorded lectures from ECHO Idaho's substance use disorder education series archives and interviews with Valley County subject matter experts to see the latest trends, the current best practices and resources for substance use disorder prevention, treatment and recovery in Idaho.
Whether you work in health care and want to claim continuing education credits or live in Idaho and want to educate yourself about substance use disorder treatment, Something for The Pain has a little something for everyone.
(wow) Words Of Wonders Level 891 Answers
Concurrent content is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC).
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ECHO Idaho uses eeds software to manage our Continuing Education (CE). To claim CE, listen to an episode
Featured: Radha Sadacharan, MD, MPH, primary care physician and MOUD provider at Centurion, Idaho Department of Corrections; and Rebecca Lee, peer recovery coach and former director of P.E.E.R. Wellness Center, Boise
…Medicaid and Medicare lose their memory every January 1st, even if your leg is amputated, they think it has grown back until it is recoded…
, a podcast produced by the ECHO Idaho Project, is designed for Idaho health care professionals working to prevent, treat and recover from opioid and substance use disorders in Valley County and the State A whole gem. I'm your host, Sam Stephen.
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In today's episode—Episode 12—I talk with Deborah Seltzer, a certified professional coder and certified risk adjustment coder at the Kootenai Care Network of North Idaho, to get a little more insight into what's involved in patient coding and billing. substance use disorder. All this is coming in today's episode
For those who receive a substance use disorder diagnosis from a health care provider, how the diagnosis is coded can not only affect how the patient is billed by Medicaid or their private insurance – it can also affect future treatment options to make them. ill
I sat down with Deborah Seltzer, certified professional coder and certified risk assessment coder at Kootenai Care Network, to talk about it.
Welcome to the program, Deborah! I was just wondering if we could tell you your full name and then where you work and what you do.
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Yes, hello. My name is Deborah Seltzer, I work for the Kootenai Care Network in North Idaho. I am a certified professional coder and a certified risk adjustment coder. And my title here is risk assessment clinical coding reviewer.
Also, I am an expert in risk coding as I was certified as a coder. And I came to the field of medical coding as the second phase of my professional life which is really common in this field. I first started as a licensed practical nurse, working in acute care nursing at several hospitals in the Southern Puget Sound and then as an outpatient clinical nurse. But after my children we traveled a lot. Really a lot. I put down my stethoscope and resigned myself to being a full-time mom. But when my children grew up it was time to look for something new again and I decided to use my knowledge of health care and go back to work in a different role.
And for those who may not know, your job title is Certified Professional Coder and Certified Risk-Management Coder. Can you talk a little bit about what the certification entails?
Unlimited. It is something that is not mandatory… you need to have some kind of degree from a university to be accepted as a professional coder. It's something that most people who have been in their role for a long time have learned along the way. But I think that with the transition from ICD-9 to ICD-10, where there was much more specificity in the coding of diagnoses, it is becoming more and more clear that people really need to be recognized in the role that they were. everyone's education was the same.
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So there are many different places that offer different accounting certification programs, but your most sought after certifications come from AAPC and AHIMA, and my certifications are through AAPC. Their CPC certification is mostly about outpatient clinical coding and AHIMA's CCS program is more about inpatient coding because there is a big difference between the two.
I mentioned a few briefs there. AAPC stands for American Academy of Professional Coders and AHIMA stands for American Health Information Management Association. I also mentioned ICD-10. This is like a major coding book, right?
Yes, it is basically a diagnostic Bible. There is ICD-10 CM, which is for outpatients, and then ICD-10 PCS, which is for inpatients. And just because certain hospital diagnoses and procedures have different codes, they use slightly different books. However, these books that are used by the World Health Organization are the same books that are used all over the world.
There are different instructions for the code you receive depending on the type of care provided. ICD-10 is a book that contains your diagnosis codes, so whatever their diagnosis is, or whatever their symptoms are, if they don't have an actual diagnosis yet, you use the code for their symptoms until you get a diagnosis. .
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And then there are the CPT codes that describe the procedures that are done, and some of this… that includes your lab and your pathology and all that stuff and some of the drugs… a lot from your HCPC codes, your Medicare codes, what is the They want to see if What are the different codes for their annual well visits and for a Medicare Advantage patient versus someone you know that he is 20 years old. So there are always different codes for different people for different things, but they all work together and do… it's just shorthand so that instead of everyone trying to decipher random notes . What the doctor should have written. Or they go through the electronic medical record, we can go to the claims data for the submitted codes and they will all tell the same story in the same language and make it a little more concise.
Yes. Every country. Every state. Even in the United States, unfortunately, some people export their medical records so they can be coded in India and the Philippines because they all use the same code. And so they may be looking at our medical information, but it's still the same code, the same code applies as if it were a patient in their own country.
Exactly And for those who are not familiar with the roles of the coder or the biller… you can walk us through the process of what kind of notes are made by the coder and then by the biller when a patient comes in to see the their care? And therefore more applicable?
Let me explain the two different roles of the coder and the reader. Sometimes they come together in a very small office, but these are usually two separate roles. And the general type of interpretation is that together with the coder and the biller, we translate the medical document from what the provider wrote in his medical notes about what they diagnosed and what procedures were done, and then it is translated. These are codes that can be submitted for payment to your insurance companies or the federal government, which is Medicaid and Medicare.
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Usually, notes from the presenters go to the coders first. They are the first to receive chart notes, and translate those notes into codes, ICD-10 CM codes or CPT codes or HCPC codes that describe the procedures, diagnoses, injections, and supplies used. -All these things are written in these codes and then that information is given to the biller so that he can send it on a claim form and send it to the payer or the insurance company or the government federal, whoever it is. He will pay the bills.
Once the biller receives that information, they are responsible for submitting the claim and then tracking the claim so that they can record any refunds or any denials or questions from insurance companies, or changes in the variable codes that can record that that happened. use Make sure everything is laid out the way the insurance company wants it to look. Because the code that you can submit to one insurance company, is the same code but if you submit it to different insurance companies, they want different variables before they are ready to pay. So it comes down to “these people want this and”.
