Study Essay example - 650 Words

Read the article Diagnosis Coding and Medical Necessity: Rules and Reimbursement by Janis Cogley located on the AHIMA Body of Knowledge (BOK) at http://www.ahima.org. This article discusses how Medicare Carriers and Fiscal Intermediaries use coverage determinations to establish medical necessity. When the condition(s) of a patient are expected to not meet medical necessity requirements for a test, procedure, or service, the provider has the obligation under the Beneficiary Notices Initiative to alert the Medicare beneficiary prior to rendering the service. The Medicare beneficiary is notified via the Advance Beneficiary Notice (ABN) (see page 235 in Appendix B). The Medicare beneficiary may choose to complete the ABN and provide†¦show more content†¦Therefore, these codes should be used to identify stable angina and documentation should support that diagnosis. Further, around $20,790.00 has been written off due to ABNs not being issued for this cardiac rehabilitation service. Questions a. What went wrong in the revenue cycle? There was no revenue. Like it is listed above after auditing the remittance advice logs and medical records, the Revenue Cycle Team has determined that medical necessity is not being met for code 93798 (Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring [per session]) and around $20,790.00 was written off due to ABN’s (Advance Beneficiary Notice) not being issued. b. How would you suggest rectifying this issue? â€Å"This article discusses how Medicare Carriers and Fiscal Intermediaries use coverage determinations to establish medical necessity. When the condition(s) of a patient are expected to not meet medical necessity requirements for a test, procedure, or service, the provider has the obligation under theShow MoreRelatedCase Studies : A Case Study Approach Essay1157 Words   |  5 PagesA case study is a specific instance that is frequently designed to illustrate a more general principle (Nisbet and Watt, 1984). Hitchock and Hughes (1995) further suggest that the case study approach is particularly valuable when the researcher has little control over evens. Case studies strives to portray ‘what it like’ to be a particular situation, to catch up reality and ‘thick description’ (Geertz, 1973) of participants’ lives experiences of, thoughts about and feelings for a situation. TheyRead MoreStudy Habits854 Words   |  4 Pagesyear level of students in sc hool becomes higher, their study habits differ from time to time. 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