How can you help a patient when the insurance company will not reimburse for procedures reported with certain diagnosis codes?

(A) Change the diagnosis codes for them.

(B) Explain that their insurance company will not cover it, and there is nothing you can do.

(C) Explain the reasons for any inconvenience.

(D) Double check the medical documentation, and ask the physician if you are unsure.

Assign the correct ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes for the following:

Anemia in end-stage renal disease (ESRD)

Note: review the Code first note for correct sequence

To better evaluate the denials of Medicare claims at ABC Hospital, Shelly (the Coding Manager) and Diane (the Fiscal Claims Manager) must work together to review documentation, ICD-10-CM/PCS code and MS-DRG assignment, and CMS denial reasons. In order to ensure an effective working environment to efficiently manage and produce MS-DRGs and the reimbursement claims, the and the departments should have a strong relationship.

(A) Medical staff and billing

(B) Finance and billing

(C) Disclosure of health information staff and coders

(D) HIM and billing staff

To better evaluate the denials of Medicare claims at ABC Hospital, Shelly (the Coding Manager) and Diane (the Fiscal Claims Manager) must work together to review documentation, ICD-10-CM/PCS code and MS-DRG assignment, and CMS denial reasons. In order to ensure an effective working environment to efficiently manage and produce MS-DRGs and the reimbursement claims, the and the departments should have a strong relationship.

(A) Medical staff and billing

(B) Finance and billing

(C) Disclosure of health information staff and coders

(D) HIM and billing staff