Medical Billing

So my “Secret Project” that I mentioned in passing in my Easter post is an online certification program I have been taking. I know, medical billing is a “chick’s” job, but I’ll be 45 here real soon and have been working on me feet since I was 14. And I have no skills outside a restaurant or bar.

Unfortunately I don’t believe I could have been talked into something more against the grain of not only my epistemology but human epistemology. I was talked into it by my wife. She used to do the job in the mid-90’s (she didn’t know you had to be certified, or was supposed to be) and a lot of it is work from home jobs nowadays. So she thought it would be cool it we both did this while she was unemployed. When she is employed now and I am stuck pursuing this most maddening of tasks by myself.

When I say against the grain of human epistemology – I mean just that. I have studied various things in my life, electronic engineering, trigonometry, music, philosophy, logic, theology (that’s a recent one, there). There is a structure to these disciplines (yes, even theology, lads) and they are taught in a structured manner. Medical coding and billing has no such structure. Half the crap you learn is the minuet of arbitrary government rules.

Get a load of some of this stuff – and note I haven’t read nor wrote a piece of fiction since I started this on February 15th – my soul (yes, laddies, there be those!) is rusting.

An example of a global prospective payment system is the Medicare system used to reimburse home health services: HHPPS, or home health prospective payment system. The Balanced Budget Act (BBA) of 1997, as amended by the Omnibus Consolidated and Emergency Supplemental Appropriations Act (OCESAA) of 1999, called for the development and implementation of a prospective payment system (PPS) for Medicare home health services. The BBA put in place the interim payment system (IPS) until the PPS could be implemented. Effective October 1, 2000, the home health PPS (HHPPS) replaced the IPS for all home health agencies (HHAs).


Step, Career. ICD-9 Professional Medical Coding and Billing. Career Step, 09/2014. VitalBook file.

And this booger of a mind- melt

Ambulatory surgical center (ASC) system –The ASC is a freestanding outpatient facility that provides outpatient surgeries to patients. Previously the payment system consisted of an ASC list with procedure codes grouped into the different payment rates. Inpatient procedures were also shifted into the outpatient setting. This trend identified a need to change the ASC list to APCs. It took many years for this transition to become a reality, and finally in 2008, the final rule established that the components of the ASC PPS would be updated every year as part of the annual OPPS rule-making process CMS uses the ambulatory payment classifications (APCs) established in the hospital OPPS as the mechanism for grouping ASC procedures. The APC relative payment weights for hospitals become the basis for calculating ASC payment rates under the new payment system.


Step, Career. ICD-9 Professional Medical Coding and Billing. Career Step, 09/2014. VitalBook file.

Translation? ASC used to be its own thing, but now it’s like APC.

And as an example of severe hierarchical inversion:

After acute care is finished, those patients that have serious long-term conditions may require extended stays. These patients may have multiple acute and chronic diseases and certainly can require complex care. Part A of Medicare provides services for this long-term care hospitalization for its beneficiaries. Services consist of 90-days in this setting. LTCH PPS was implemented in 2002. Many of these patients have chronic diseases such as cancer, tuberculosis, respiratory conditions and head trauma. Many of these patients are ventilator-dependent or require extensive rehabilitative services. Because these lengths-of-stay (LOS) are so much longer than an acute inpatient stay, there is a special reimbursement. The average LOS may be about 25 days or longer. The system is very similar to the MS-DRG system, but the calculations are different to account for this special circumstance. The PPS is based on MS-LTC-DRGs. They actually have the same groups as the MS-DRGs that are in effect for acute-care hospitals. The main difference is that the MS-LTC-DRGs have different relative weights and so therefore different payments.


Step, Career. ICD-9 Professional Medical Coding and Billing. Career Step, 09/2014. VitalBook file.

I had to look up both MS DRG and MS-LTC-DRG. Why? Because MS-DRG is not even a subject for another 20 pages!

And I do not know how many times I have had to click on a link (they provide them all over the text) and have to read an additional mind-numbing 20 pages on Medicare jargon!

And the acronyms! Mind you I still have three whole sections on biology and medical terminology and pharmacology to master. But there are about five to 10 new one every page and some of them are doozies. Try this one on.

IRF PAI – Inpatient Rehabilitation Facility Patient Assessment Instrument

I have a headache.


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