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Evaluation and management coding (commonly known as E/M coding or E&M coding) is a medical coding process in support of medical billing. Practicing health care providers in the United States must use E/M coding to be reimbursed by Medicare , Medicaid programs, or private insurance for patient encounters.
Planning & delivery of care; Evaluation of results for each patient & adjustment of the care plan; Evaluation of overall program effectiveness & adjustment of the program [4] In the context of a health insurer or health plan it is defined as: [5] A method of managing the provision of health care to members with high-cost medical conditions.
HCPCS was established in 1978 to provide a standardized coding system for describing the specific items and services provided in the delivery of health care. Such coding is necessary for Medicare , Medicaid , and other health insurance programs to ensure that insurance claims are processed in an orderly and consistent manner.
(99324–99337) Domiciliary, rest home (boarding home) or custodial care services (99339–99340) Domiciliary, rest home (assisted living facility), or home care plan oversight services (99341–99350) Home health services (99354–99360) Prolonged services (99363–99368) Case management services (99374–99380) Care plan oversight services
Medical billing, a payment process in the United States healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed.
The Clinical Care Classification (CCC) System is a standardized, coded nursing terminology that identifies the discrete elements of nursing practice. The CCC provides a unique framework and coding structure. Used for documenting the plan of care; following the nursing process in all health care settings. [1]
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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...