RANGE OF VARIABLES VARIABLE Supporting documents May include but not limited to: Patient’s record (diagnostic examination result) Medical provider’s Diagnoses code set, procedure code set and supplies code set Billing record Posting of payments May be classified as: paid under paid rejected or denied Rejected claims May be caused by but not limited to: Incomplete/incorrect patient information Illegible/unreadable documents Incorrect medical Incomplete/incorrect providers information Reasons for May include but not limited to: underpayment Medically unnecessary procedure, supplies and/or equipment Not covered by benefit plan Exceeded coverage plan Unauthorized procedure, supplies and/or equipment Duplicate billing Bundled medical procedure codes EVIDENCE GUIDE Critical aspects Assessment must show that the candidate: of competency Managed account receivable Managed rejection/denials Managed underpayment Methods of The following may be used to objectively assess the assessment candidate: Demonstration with oral Questioning Written test Portfolio with interview Resource The following resources May be provided: implication diagnosis coding manuals Procedures/Services and supplies coding Manuals and/or equivalent Mockup/Sample Medical documentation Context of Assessment may be conducted in the workplace or in a Assessment simulated environment.
RANGE OF VARIABLES VARIABLE Supporting documents May include but not limited to: Patient’s record (diagnostic examination result) Medical provider’s Diagnoses code set, procedure code set and supplies code set Billing record Posting of payments May be classified as: paid under paid rejected or denied Rejected claims May be caused by but not limited to: Incomplete/incorrect patient information Illegible/unreadable documents Incorrect medical Incomplete/incorrect providers information Reasons for underpayment May include but not limited to: Medically unnecessary procedure, supplies and/or equipment Not covered by benefit plan Exceeded coverage plan Unauthorized procedure, supplies and/or equipment Duplicate billing Bundled medical procedure codes EVIDENCE GUIDE Critical aspects of competency Assessment must show that the candidate: Managed account receivable Managed rejection/denials Managed underpayment Methods of assessment The following may be used to objectively assess the candidate: Demonstration with oral Questioning Written test Portfolio with interview Resource implication The following resources May be provided: diagnosis coding manuals Procedures/Services and supplies coding Manuals and/or equivalent Mockup/Sample Medical documentation Context of Assessment Assessment may be conducted in the workplace or in a simulated environment.
tr%20medical%20coding%20and%20claims%20processing%20nc%20iii.docx