enifer: Why does location matter related to reimbursement?
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Manuela Noel Week 2 DiscussionCOLLAPSE
How does the location of where a service is performed determine which code set is used? Relate issues such as reimbursement schedules, co-pay amounts, and coverage limitations.
The location of place of services should always be code accurately when it comes to different setting that services is being rendered. For example, a check at your primary care doctor will be a different code and fee than conducting a minor surgery procedure at an outpatient clinic.
What is a reimbursement schedule?
Reimbursement schedule is a set of listing fee schedule used by healthcare insurance company (Medicare) to pay doctors, providers, or suppliers which is used to reimburse healthcare professionals on a fee for service basis. For example, after a patient undergo services from a doctor office or hospital the insurance company or government payers reimburse for the service that was provided.
What is a copay?
Copay is a fixed amount that is being covered by a patient before seeing a health care professional to rendered service. For example, a patient goes in to see their primary care doctor to conduct a physical check-up for the visit at the office the fee to see the doctor id $89.00 the insurance covers for the visit however, for the procedure that is being provided the patient will need to cover the remaining 25% of service which is the copay.
4. What type of service does the term “procedure coding” includes?
Some of the procedures includes:
– Medicine (90281 to 99607)
– Anesthesia (00100 to 01999)
– Radiology (70010 to 79999)
– Evaluation and Management (99201 to 99499)
– Pathology and Laboratory (80047 to 89399)
– Surgery (10021 to 69990)
Aalseth, P. (2015). Medical Coding: What it is and How it Works ; Second Edition (2nd ed.). Jones and Bartlett Learning.
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