2023 1 Prepare examples of various coding and billing issues that you have experienced in the clinical

1. Prepare examples of various coding and billing issues that you have experienced in the clinical setting (Peds and women’s health).

2. Provide a brief description about the NPI numbers for nurse practitioners.

Read the following article:

https://journals.lww.co m/jwocnonline/Fulltext/ 2012/03001/Reimburse ment_of_Advanced_Pra ctice_Registered.4.aspx

answer:

During my previous clinicals, I have noticed providers complaining about different coding and billing issues. The most common complaint was not having enough data. If the provider fails to provide enough information, like not linking the diagnosis to the right CPT code then the payer may deny the transaction or create a delay. Another common issue includes having to uncode if the patient is billed for the wrong services. Many other errors like telemedicine coding errors, missing or incorrect information and incorrect procedure codes. Although there are many possible errors, there is also multiple ways to avoid them. It is the providers job to prevent those errors (Grant-Kels, Kim, & Graff, 2016). 

A National Provider Identifier is a unique 10-digit number given to healthcare providers by Medicare and Medicaid services. This NPI number was brough around 1996 under HIPAA. It was then in 2006 when it became mostly used. This allows the provider to identify themselves in transactions or medical correspondence. The provider will carry this unique code throughout their career to any practice that they join (Adams, Norman, & Burroughs, 2020). This is not a confidential number since anyone can look up an NPI number in the registry. Finally, in order to obtain one, the provider must apply under the NPPES website. 

References

Adams, D. L., Norman, H., & Burroughs, V. J. (2020). Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors. Journal of the National Medical Association, 94(6), 430–447.

Grant-Kels, J. M., Kim, A., & Graff, J. (2016). Billing and up coding: What’s a doctor-patient to do?. International journal of women’s dermatology, 2(4), 149–150. https://doi.org/10.1016/j.ijwd.2016.08.003