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Front Office Procedures

Front Office Procedures. Coding and Insurance. Coding consists of . . . . Diagnostic Coding. Procedural Coding. What is Diagnostic coding???. Coding is converting verbal or written descriptions into numeric designations. For example:. 784 is the diagnostic code for. . . Headache . Ouch!.

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Front Office Procedures

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  1. Front Office Procedures Coding and Insurance

  2. Coding consists of . . . • Diagnostic Coding • Procedural Coding

  3. What is Diagnostic coding??? • Coding is converting verbal or written descriptions into numeric designations

  4. For example: • 784 is the diagnostic code for. . .

  5. Headache • Ouch! Headache!

  6. This is how it works- • An insured patient goes to see his doctor for a headache. • Then Doctor X gives the headache a code number (784) • And sends the proper paperwork to the patients’ insurance company with that code number.

  7. Coding . . .yeah! • ABC Insurance company receives the paper work with the code: 784 • For the patient and one look at the number tells ABC Insurance company that their insured was seen for a 784 • Or. . .

  8. OUCH • A Head Ache!

  9. Procedure codes • Mr. Bean has seen Doctor X several times over the last three years, this makes him an. . . • ESTABLSIHED PATIENT

  10. Procedure codes • Mr. Bean saw Doctor X for a short visit –about 15 minutes • And he only had one problem to discuss with the doctor • Mr. Bean’s visit was a problem focused, limited exam

  11. Procedure codes –yippee! • So Doctor X sends this information to Mr. Bean’s Insurance company as well, in the form of a number. • This number is for the procedure • It is called a Procedure Code • 99212

  12. Codes, codes, codes • Once ABC Insurance Company receives the paper work, called a claim, they review the code numbers and . . .

  13. Codes, codes, codes • Decide what to pay Doctor X

  14. Amount due: • Doctor X bills ABC Insurance Co. • $175.00 for an office visit • ABC Insurance Co. only has to pay Doctor X a portion of that amount. • They decide to pay. . .

  15. payment • $75.00

  16. Everyones happy

  17. Because • The doctor gets paid. • The patient only has to pay a small amount of money to see his doctor- this is called a Co-pay.

  18. Everyone is happy • ABC Insurance will continue to receive monthly amounts of money from Mr. Bean- this is called a premium. • AND- Mr. Bean has already paid his deductible, which is an amount of money that Mr. Bean has to pay every year towards his Insurance claims.

  19. Recap- • Mr. Bean pays a small amount out of his paycheck every month so that when he goes to see his doctor, Doctor X, he only has to pay a vary small amount called a co-payment. • Doctor X’s office collects the co-payments from their patients, like Mr. Bean and the monies collected from the Insurance companies and this is how the office makes money

  20. Insurance coding • The End.

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