Healthcare Coding, Billing and Reimbursement: An Overview

Overview:

Many people work with various aspects of healthcare coding and billing but may not understand how providers generate their claim data, how they report the data to payors, and how payors use that information to reimburse providers. This webinar provides a high-level overview of all major aspects of healthcare coding, billing, and reimbursement.

We discuss key data elements of the two major claim forms (CMS-1500 and UB04) and how that information tells the story of the patient’s encounter with the provider. We review the major coding systems including CPT, HCPCS, ICD-9, ICD-10, DRG, and APC, and examine how codes in each system are assigned and the purpose of each system. We review the typical process flow for how a provider submits a claim and gets reimbursed. We discuss the fundamentals of physician and hospital reimbursement, including a brief conversation of relative value units (RVUs) are and how they are used to reimburse providers. We discuss commonly used methods to reimburse hospitals, including per diems, per stay, DRGs, and APCs. Finally, we review common pitfalls that analysts encounter when working with healthcare claims data sets and how to be on the watch for them.

Why should you Attend: This webinar is ideal for persons who work with healthcare claims data and who want to better understand the fundamental elements of billing, coding, and reimbursement. You will learn about how physicians, hospitals, and other healthcare providers bill for their services and how payors use that information to adjudicate the claim. You will also learn about the major healthcare coding systems and how coding data are used for analysis and reporting.

Areas Covered in the Session:

• Key data elements on healthcare claim forms (CMS-1500 and UB04)
• Explanation of the major coding systems including CPT, HCPCS, ICD-9, ICD-10, DRG, and APC
• Discussion of how providers compile charges and assign codes
• Brief process flow for submitting claims and getting reimbursed from payors
• Explanation of RVUs and how they are used
• Discussion of common reimbursement methods for physicians, hospitals, and surgery centers
• Common pitfalls incurred when working with healthcare data and how to be on the watch for them

• Healthcare Data and Claims Analysts
• Healthcare Researchers
• Billers and Coders
• Providers