Northwest Partnership for Public Health .

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Addressing Medical Billing Challenges in Public Health. CPT Code 96372 ICD-9 Code V25.49 HCPCS Code J1055. Northwest Partnership for Public Health. Also called the Northwest Incubator Group of 10 county health departments Innovative projects for the betterment of public health
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Tending to Medical Billing Challenges in Public Health CPT Code 96372 ICD-9 Code V25.49 HCPCS Code J1055

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Northwest Partnership for Public Health Also called the Northwest Incubator Group of 10 district wellbeing offices Innovative undertakings for the improvement of general wellbeing Health Directors go about as Board Legislative subsidizing for ventures

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Definition of Plan Lack of accentuation on income era Increases in quantities of patients/reductions in subsidizing Correct coding and medicinal charging hones an unquestionable requirement for Health Departments Ashe County Health Department

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Definition of Plan Medical Billing Consultant accessible to the LHD to help with: coding issues charging issues assessments meetings preparing Health Department purchase in through Health Director, nursing chiefs, regulatory bolster staff and suppliers Alleghany County Health Department

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Definition of Plan Four areas will be at first steered amid Year 1: Davidson Surry Wilkes Yadkin Initial subsidizing through the Incubator Collaboratives, then expense for-administration structure

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Job Description CPT and ICD-9 changes Evaluation and Management (E&M) code preparing Primary Care code Training Family Planning code preparing Immunization code preparing Diabetes Management Self Training (DMST) and Medical Nutrition Training (MNT) code preparing

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Job Description (con\'t) Credentialing with Insurance Companies Be accessible for coding inquiries and site visits Assistance with money related arrangements and techniques Assistance reconsidering experiences Assistance with expense plan

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Question: It\'s only a basic code. What could turn out badly??

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Procedure really performed Pt had a Pap spread Pt was charged for a Pap spread Procedure codes charged Procedure codes were accurately utilized Pap spread charged & likewise performed

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Pap spread was done however not charged for Missed charges Additional codes that could have been charged including codes missing from the experience shape A Pap spread was done yet it was not on the experience frame and the supplier did not compose it in

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Companion codes and modifiers that could have been charged and would expand repayment A Pap spread was done & sent to an outside lab yet the extra example taking care of code was not charged A Pap Smear was done but rather the doctor\'s request wasn\'t reported Documentation blunders

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Operations and Management Fiscal specialist is Appalachian District Health Department Incubator Director will enroll, procure and regulate Position will be 1 FTE, housed in Wilkes On-the-occupation preparing in Public Health Office of State Personnel characterization as Medical Records Assistant V

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Yadkin County Health Department

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Sample Encounter Form

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Demonstration of Need and Target Market Recent reviews of 9 northwest North Carolina regions appeared: Average of 6 invalid/wrong CPT (Current Procedural Terminology) codes per province Average of 4 abused codes for every area In one region alone, 46 methodology were performed yet not charged/charged Lack of review devices/no general framework for examining

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Demonstration of Need and Target Market Services *Limited number of patients served *Cuts in projects and administrations Revenue *Decreased monies from Federal, State and Local Agencies. *Increase Medicaid, outsider protection and private dollars *Outdated CPT Codes as well as Encounter Forms *Pay-back of Medicaid/Insurance dollars Training *Improperly prepared staff *Consultants

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Demonstration of Need and Target Market (con\'t) "Charges might be based upon an arrangement Recommended by the nearby Health Director and affirmed by the neighborhood Board of Health and the suitable County Board or Boards of Commissioners" (130A-39g).

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Demonstration of Need and Target Market (con\'t) Four essential reasons that right coding ought to be a need for neighborhood general wellbeing: Incorrect coding is illicit Incorrect coding is untrustworthy Incorrect coding is ill advised Correct coding and charging will expand income

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Market Strategy This strategy for success will be the administrations of a restorative charging expert. It will be offered to general wellbeing offices. Wellbeing Directors, as the guards to nearby general wellbeing, will be focused on above all else. Mike Reavis, Yadkin County Health Director

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Marketing Strategy Word of Mouth Email Presentations State Conferences

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Wilkes County Health Department

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Industry Analysis The human services industry in the US: $2 trillion industry Third gathering safety net providers pay out $700 billion Medicare and Medicaid make yearly installments of $1 trillion Annual income of $1.5 trillion for care suppliers Information gave by First Research, a deals counseling firm. Consequently, restorative coding might be said to be the greatest achievement figure for any therapeutic office. Doing it effectively can mean the steadiness of your business. Doing it erroneously could mean the ruin of your practice.

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Industry Analysis Hundreds of a great many dollars are lost every year because of restorative charging blunders. The national pattern for altering these issues comprises of: Having a coding/charging master in house that stays fully informed regarding current changes in Medicare, Medicaid and outsider charging prerequisites. Bigger partnerships contract a territorial coder that is in charge of preparing and charging consistence for more than one office. Outsourcing to a medicinal charging and coding organization that are frequently found seaward.

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Industry Analysis (con\'t) Currently there are 3 Health Departments near the Northwest that have "coders": Cabarrus, Guilford and Mecklenburg Otherwise, NC wellbeing offices utilize state specialists. Every specialist has anywhere in the range of twenty to a quarter century and are in charge of: Accreditation Policy and Procedures Quality Improvement CPT coding reviews and preparing Support in enhancing efficiencies Generalized nursing counsels Clinical specialists for the new HIS framework They are amazingly important asset. Nonetheless, they have restricted time to help with individual wellbeing offices. Not as ready to help with outsider charging and protection credentialing.

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Davidson County Health Department

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Competitors and Partners Are assorted and traverse province and state lines and even into the private segment Partners appear as neighborhood, provincial and state level faculty, essentially in broad daylight benefit offices Health Directors, wellbeing office staff, Boards of Health and County Commissioners shape the foundation of our bolster Their bolster helps: The therapeutic charging specialist give significant coding preparing; Health offices will give general wellbeing preparing Our of state accomplices who are a profitable resource for the LHD will be the Nurse and Administrative Consultants

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Competitors and Partners (con\'t) The medicinal charging advisor will share the weight for coding questions Our accomplices would be keen on taking an interest in this arrangement since: We offer a prepared and proficient expert Work burdens are diminished Potential payback circumstances are diminished Creates less reliance on allow monies

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Competitors and Partners Numerous rivals in our business: Web-based preparing Insurance organizations Other counseling firms CPT coders Using just the "Goggle" web index for associations in NC: 1,170,00 hits for Public Health Medical Billing Consultant 73,700 hits for Public Health Medical Coder Consultant 1,180,000 hits for Public Health Medical Coder

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Competitors and Partners Numerous rivals in our business: Web-based preparing Insurance organizations Other counseling firms CPT coders Using just the "Goggle" internet searcher for associations in NC: 1,170,00 hits for Public Health Medical Billing Consultant 73,700 hits for Public Health Medical Coder Consultant 1,180,000 hits for Public Health Medical Coder

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Competitors and Partners (con\'t) Five Organizations offering administrations like venture: TCN, The Coding Network in Beverly Hills, CA Medical Coding Services, LLC in Pendleton, IN Healthcare Business Consultants in Asheville, NC Healthcare Management & Consulting in Bay Shore, NY Health Care Economics in Indianapolis, IN Of these five associations, Healthcare Business Consultants offers counseling exhortation yet it doesn\'t have general wellbeing mastery nor does it show it\'s costs.

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Surry County Health Department

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Risk and Exit Plan Few dangers exist because of financing as of now secured for a long time Health office purchase in might be troublesome A potential hazard is a State purchase out of the venture or if OSP made another position for LHDs. On the off chance that this happens: NW Partnership discharge control and budgetary commitment to express A test would partition income (assuming any) among partaking provinces Consultant would be reassigned or lose position

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Risk and Exit Plan (con\'t) If there were an accidental leave: Medical charging task would not proceed with absence of structure If in the early stages, the expenses would be negligible The in-kind space would be reallocated Computer and specialized hardware exchanged back to NW Partnership All leave expenses would be on the Partnership One technique for tending to this plausibility: Restructure and the advisor be claim private and monetary agent This would at present be a test because of absence of region cash or a administering load up

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Pre-March 2009 Make introductory contacts; NWPPH will vote to affirm strategy for success March 2009—July 2009 Collect data, compose expected set of responsibilities Obtain endorsement of set of working responsibilities Post position Conduct talk with; make offer to qualified candidat

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