How does accurate (and complete) coding ensure fair payment and help managers identify ways to improve quality and areas of focus/improvement?

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Policy Evidence

  • Effective 2019, CMS issued a revised version of the National Correct Coding Initiative Policy Manual for Medicare Services. This manual was developed to promote updated coding methodology and to control for improper coding which leads to inaccurate payments of Medicare Part B claims. source
  • Current Procedural Terminology (CPT) is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations. source
  • The ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States. source

Outcome Evidence

  • In 2015, the ICD-9 codes were updated to ICD-10 after 30 years. There was concern among providers over the disruption the transition would cause. A study conducted 6 months post transition found the for the most part claims have been successfully submitted and processed. There were no reports of a high rate of claims denials or rejections, or big drops in the volume of claims submitted. source

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