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Key Concepts Reply to each Peer about their post.

Key Concepts Reply 1 to Yanira:

Hello classmates,

We’re discussing some of the terminologies frequently used and known in the healthcare organization for this week. ASC is an Ambulatory Surgical Center, which often is used only for same-day surgeries. According to ASC (2020), “By operating in ASCs instead of hospitals, physicians gain increased control over their surgical practices.1 In the ASC setting, physicians can schedule procedures more conveniently, assemble teams of specially trained and highly skilled staff, ensure that the equipment and supplies being used are best suited to their techniques, and design facilities tailored to their specialties and the specific needs of their patients.” ASC is a convenient alternative option to schedule surgeries at a faster date compare to hospital availability. This is why it’s easier for the surgeons to plan surgeries and their clinic around their surgery times.

CPT, also known as Current Procedural Terminology, are codes that are used to describe the type of procedure the office is billing for. Insurance companies use these codes to determine the coverage that pertains to the codes. According to CMS (2010), “We update the Code List to conform the list to the most recent publications of CPT and HCPCS and to account for changes in Medicare coverage and payment policies.” Although this CPT code is updated often, the codes say almost similar to what the code currently means. Sometimes the codes change when they combine two different surgeries in one.

Reference:

ASCs: A Positive Trend in Health Care. (n.d.). Retrieved November 18, 2020, from https://www.ascassociation.org/advancingsurgicalca…

Code List for Certain Designated Health Services (DHS). (n.d.). Retrieved November 18, 2020, from https://www.cms.gov/Medicare/Fraud-and-Abuse/Physi…

Key Concepts Reply to Priscilla:

Since there are many different types of healthcare providers and healthcare payment systems, there are also different types of business structuring. According to Abbey (2010), “Business structuring generally relates to different forms of tax recognition” (p. 50). Business structures may change at any time depending on the healthcare providers. Also, depending on the size of the organization, the complexity of business structures will vary.

Healthcare Common Procedure Coding System (HCPCS) “is a standardized code system necessary for medical providers to submit healthcare claims to Medicare and other health insurances in a consistent and orderly manner” (AAPC Advancing the Business of Healthcare, 2020). HCPCS is made up of two sets of medical code, which are HCPCS Level I and HCPCS Level II. HCPCS Level I is composed of the code set of the Current Procedural Terminology (CPT), and it is used for submitting medical claims to payers for all the services and procedures carried out by hospitals, physicians, etc. For HCPCS Level II, it is the national procedure code set, which is used by providers, practitioners, and medical equipment suppliers for identifying supplies, services, products, medications, etc. that is not included in the CPT codes (AAPC Advancing the Business of Healthcare, 2020). An example of HCPCS codes for medical and surgical supplies are range from A4206-A8004.

Current Procedural Terminology (CPT) “refers to a set of medical codes used by physicians, allied health professionals, nonphysician practitioners, hospitals, outpatient facilities, and laboratories to describe the procedures and services they perform” (AAPC Advancing the Business of Healthcare, 2020). In order for reimbursement of rendered healthcare, healthcare providers will use the CPT codes to report services and procedures to the payers. CPT codes are classified into three types, which are Category I, Category II, and Category III. Category I are the most common codes used by healthcare providers in order for them to report their procedures and services, Category II are supplemental tracking codes that are used for performance management, and Category III are temporary codes that are used to report experimental and emerging procedures and services (AAPC Advancing the Business of Healthcare, 2020). An example of CPT codes for radiology procedures are 70010-79999.

References

AAPC Advancing the Business of Healthcare. (2020). All About HCPCS Codes. https://www.aapc.com/resources/medical-coding/hcpcs.aspx.

AAPC Advancing the Business of Healthcare. (2020). What is CPT®? https://www.aapc.com/resources/medical-coding/cpt.aspx.

Abbey, D. (2010). Healthcare payment systems: An introduction. Boca Raton, FL: Productivity Press.