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 you should 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
Who Will Benefit:
- Healthcare Data and Claims Analysts
- Healthcare Researchers
- Billers and Coders
Speaker ProfileRich Henriksen is the Chief Executive Officer and founder of Nokomis Health. Rich has 30 years of experience in healthcare systems, coding, billing, and reimbursement. He has led managed care departments and provider contracting units at a variety of organizations, including hospitals, clinics, and health plans.
Rich has worked with over 70 different organizations, ranging from hospitals and clinics to third-party administrators, law firms, and internet-based companies. As a respected industry expert, he is well known for his unparalleled depth of knowledge in all aspects of healthcare coding, billing and reimbursement.
Rich received his Bachelor of Arts in biology from Luther College in Decorah, Iowa, and his Master of Arts in Healthcare Administration from The University of Iowa. He resides in Minneapolis, Minnesota where he leads the Nokomis Health team on their mission to set a new standard for medical claim review.