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Coding for Hipaa: How to Report Professional Claims

Coding for Hipaa: How to Report Professional Claims

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Book DescriptionCoding for HIPAA takes readers from the paper-based world of health care claims and gives them the data content knowledge necessary for reporting claims in the HIPAA environment. In clear language, this resource examines the CMS 1500 claim form in detail and gives a brief overview of the electronic transactions standards mandated by the U.S. Department of Health and Human Services.

This book also provides a comprehensive education on elements not found in other HIPAA publications, particularly the non-medical code sets required under HIPAA. These code sets include:

-A complete list of the Provider Taxonomy code set - Used to identify provider type and area of specialization

-Claim Adjustment Reason - Used to communicate why a claim or service line was "adjusted"

-Remittance Advice Remark - Used to add greater specificity to a Claim Adjustment Reason Code

-Claim Status Category - Used to indicate the general category of the status of a claim within the adjudication process

-Claim Status - Used to communicate information about the status of a claim

-Place-of-Service - Used to specify the entity where service(s) are rendered