Test 1 Flashcards
1
Q
HMO
A
health maintenance organization plans
2
Q
PPO
A
preferred provider health organization
3
Q
HSAs
A
health savings accounts
4
Q
HRA
A
health reimbursement arrangements
5
Q
POS
A
points of service
6
Q
Electronic claims processing
A
90% of insurance claims are filed electronically
7
Q
subscriber
A
the insured
8
Q
assignment of benefits
A
authorization for insurance carrier to pay the physician or practice directly
9
Q
carrier
A
insurance carrier
10
Q
premium
A
basic annual cost
11
Q
deductible
A
fixed dollar amount that must be paid or met once a year before the insurer begins to cover expenses
12
Q
copayment
A
small fee paid at the time of service
13
Q
coinsurance
A
fixed percentage of covered charges ofter deductible is met
14
Q
exclusions
A
uncovered expenses such as eye exams or dental care
15
Q
health insurance provider
A
insurance company
16
Q
provider of medical services
A
the doctor
17
Q
claims process
A
obtain patient information
delivery of service to a patient and determination of diagnosis and fee
recording payment form the patient and preparing insurance claim forms
reviewing insurer’s processing of the claim, explanation of benefits, and payment
18
Q
Patient registration form
A
name current address current telephone number date of birth social security contact in case of emergency current employer employer address and number insurance carrier and effective date of coverage group plan number name of insured patient signature
19
Q
CPT
A
Current procedural terminology
published by the AMA
20
Q
What is CPT?
A
contains diagnoses and treatment codes, it is the responsibility of the person doing the insurance billing to translate the medical terminology on the charge slip into precise descriptions of the medical services, procedures and codes corresponding to that patient.
21
Q
Health insurance history
A
First offered in the US in 1847 (accident insurance was offered three years later)
Coverage was only for income loss because of disability from an illness
Did not cover basic medical expenses
In 1929, the first group coverage started
22
Q
Claim forms
A
filled out either manually of electronically
physician must sign the forms (not medicare)
There are time limits to file claims
23
Q
Insurer’s processing and payment
A
review for medical necessity
review for allowable benefits
payment and explanation of benefits
24
Q
review for medical necessity
A
determination of whether the diagnosis and treatment are compatible and whether treatment was medically necessary
25
review for allowable benefits
comparing fees the doctor charges with the benefits provided by the patien's health insurance policy; determination of deductible or co-payment patient owes
26
payment and explanation of benefits
after review, insure pays benefit either to subscriber or to the practice; with the payment an EOB is sent
27
EOB
explanation of benefits
28
What is an EOB?
```
gives the following information
name of subscriber
identification number
name of beneficiary
claim number
date
place
type of service
amount billed
amount allowed
amount of subscriber liability
amount paid
notation of any services not covered and why
```
29
UCR
Usual, Customary and Reasonable fees system The UCR for federally funded insurance is applied by Congress. This included Medicare, Medicaid, Champus/Tricare and Champva. By law, providers must accept the UCR fee as payment in full. They cannot bill the patient for the difference.
30
Customary fee
This is either the average fee charged for the procedure by similar doctors in the same region or the 90% of the fees charged for the procedure by similar doctors in the same area. The insurance company calculates the 90th percentile rate. The Physician Fee Guide published by Practice Management Information Corporation in Los Angeles lists fees for all current procedural terminology (CPT) codes.
31
UNIVERSAL HEALTH INSURANCE CLAIM FORM- CMS-1500:
* Health Care Financing Administration (HCFA)
* Designed by congress
* Originally used for Medicare and Medicaid claims
* Now used also by many insurance carriers
* The CMS-1500 form must be completed properly
* CMS-1500 forms should not be duplicated; originals must always be used for each claim.
32
Rules to follow file CMS 1500 claim forms
* keep information inside field
* align paper
* do not enter data by hand
* use all uppercase (capitals)
* don’t use colored ink
* don’t use N/A for a field if not applicable; instead, leave blanks
33
Fee-for-Service (or Indemnity) Plans
With this traditional plan, you can make an appointment with almost any medical provider. After your visit, you or your provider sends your claim to the insurance company. If you have met your deductible for the year, then the Fee-for-Service plan will pay a percentage of the bill - usually 80%. You pay for the other 20%, known as coinsurance. Few purchase this traditional type of plan. Why? Because it's expensive.
34
Managed Care
This term refers to types of health insurance plans that provide health care services at a lower cost. The key to these lower costs? Members of managed care plans must adhere to certain rules designed to lower the cost of medical care
35
Types of managed care
HMOs: health maintenance organizations
PPOs: preferred provider organization
POSs: point of service
36
What is Health Maintenance organization HMO?
* Provide specific services to individuals and their dependents who are enrolled in them
* Payment to providers is mostly done by capitation
* Physicians enrolled in these plans are called participating providers
* The patients must go to participating providers only
* Described as managed care organizations because they manage, negotiate, and contract for health care
* Main goal is to keep health-care costs down (this is the primary purpose of HMOs)
* Focus is on wellness and preventive care
* Encourage patients to have annual check-ups
* Copayments are usually $10 or $20 per visit (goes up higher every year)
* Many Medicare and Medicaid patients receive their benefits through an HMO
* Became popular in the 1980’s
37
Types of HMOs
Staff moder HMO
Individual practice associations IPAs HMO
Group model HOM
Open ended HMO
38
Staff Model HMO
A form of HMO in which doctors are employees of the HMO and you see them at a central medical facility.
* All services (physical therapy, x-rays, etc) are provided at the same location or a central medical facility
* PCP is responsible for routine care and referrals
* True emergencies do not require preauthorization
* Patient must however be preauthorized if they are outside their service area
39
Individual Practice Associations HMO (IPAs)?
Here, an HMO contracts with outside physician groups or individual doctors who have private practices. This means the HMO network will include doctors in various locations rather than only at a central facility.
* HMO contracts with outside physician groups or individual doctors who have private practices.
* HMO network will include doctors in various locations rather than only at a central facility such as the Staff model
40
What is Preferred Provider Organization (PPO)?
This isn't an HMO, but it is another type of managed care. In this system, you may seek treatment from an approved network of providers, or may see other providers outside the network. Usually, you will pay small copay and satisfy a deductible before benefits are paid. Then you'll pay a set coinsurance amount. It's less expensive to visit one of the providers in the plan's list. You can go outside the plan's list, but your share of the bill will be higher.
41
What is Point of Service (POS)?
A hybrid of the HMO and PPO is known as a POS plan. Like a standard HMO, your primary care doctors make referrals to other providers within the plan. But if you want to go to a physician outside the network without consulting your primary care doctor, the POS plan will pay a predetermined amount of the bill and your share of the bill will be higher than it would if you stay in-network. These plans usually cost more in monthly premiums than straight HMOs, but they give you the flexibility to call any doctor - within the plan or not
* A network of physicians and hospitals that contract to provide an insurance company or an employer with services for their members or employees at a discount rate (this is like a hybrid of the HMO and PPO)
* Primary care doctor makes referrals to other providers within the plan, but if the patient wants to go to a physician outside the network without consulting the primary care doctor, the POS plan will pay a predetermined amount of the bill and the share of the bill will be higher than it would if the patient had stayed in-network.
* This benefits the insurance company by reducing the cost of care, which in turn should reduce the cost of the insurance for the employer
* The physicians benefit by gaining a group of patients from whom they can receive payments.
42
Copay
A fixed dollar amount you pay at the time services are rendered. Typical copays are for office visits, prescriptions, or hospitalizations.
43
Coinsurance
A specified percentage of the cost of treatment the insured is required to pay for all covered medical expenses remaining after the deductible has been met
44
Deductible
The portion of your health care that you pay before insurance starts covering it. Typically, the higher the deductible, the lower the premiums.
45
Pre-existing condition:
An illness, disease or condition an individual has at the time of enrollment in a health care plan.
46
Premiums
The monthly or quarterly payments paid for health insurance.
47
Catastrophic coverage:
This plan pays hospital and medical expenses above a certain (usually high) deductible. The maximum lifetime limit may be high enough to cover the cost of a catastrophic illness.
48
Long-term care policies:
These cover medical care, nursing care and certain in-home care if you ever become unable to care for yourself due to an extended illness or disability.
49
Disability income insurance:
This plan will provide you with an income if you become unable to work due to an injury or illness. Benefits are usually 60% of your income at the time of disability.
50
What is Group model HMO?
* Are multispecialty practices contracted to provide health care services to members.
* Physicians are reimbursed on a capitated basis. (physicians are paid a set fee per patient on their list each month, whether the patient is seen one or more times or not at all)
51
What is Open-ended HMO?
* Allows members greater freedom in their choice of care; they do not have a PCP and can self-refer to specialists.
* If patient chooses a nonpanel provider, the benefit is more like an indemnity plan with a deductible and coinsurance
52
What is a PPO?
* Physicians under contract agree to accept predetermined fees
* Deductibles are paid by patients
* Patient has the option of using network or non-network physicians and hospitals, but if non-networks is used, it is more expensive
* Members do not have a PCP
53
What is Consumer-Driven Health Plans (CDHPs)?
* Created by the Federal government in 2003
* It is a health savings account
* Have high deductibles & low monthly premiums
* A set amount of money is available to pay for health services so the patients like to first find out how much a doctor charges
54
What is Health Savings Account (HSA)
* Is tax-sheltered savings account
* Similar to an IRA
* Any money not used, remains in the account from year to year just gaining interest
* Has a high deductible (preventive care doesn’t use deductible)
* Contributions are made by the employee or the employer
* The max contribution for 2006 were $2,650 for an individual and $5,250 for a family
* Small medical expenses can be paid for as they are considered a qualified medical expense (ambulance service, braces, home improvements to assist a disable person for example)
55
What is Health Reimbursement Account (HRA):
* Used to pay for medical expenses
* Can be paired with a standard or high deductible health plan
* Only the employer can contribute to an HRA
* In 2006, there were no restrictions as to the amount of contribution
* The employer owns the money in this account, and it is not portable when the employee leaves the company
56
What is Flexible Spending Account (FSA):
* It is referred to as a “cafeteria plan”
* There are 3 components: health insurance premiums, qualified medical expenses and dependent care expenses
* Funded by the employee
* It is a “use it or lose it” plan
* Money belongs to the employee; money unused is returned to the employer
* Employees are not required to pay any Federal, Social Security, or state (in most cases) taxes on contributions.
57
Birthday Rule for payment from insurance:
If in a household, 2 people have 2 different insurances, the person whose birthday comes first – their insurance gets billed first.
• If both parents have the same birthdates, the plan in effect the longest is primary
• If parents divorce and retain their plans, the parent with custody is primary
• If a court order exists that dictates which parent is responsible for medical expenses, the court order supersedes
58
Submitting claims electronically:
* Easy
* Saves time- less paper work
* Faster reimbursement- 14 days
* As of July 1, 1996, all computer systems must use National Standards Institute Format to send claims electronically to Medicare
* Three things are needed: a computer, a modem and an electronic claims submission software
59
Releasing information from medical office:
Release of Medical Information Form must be signed for this
60
Releasing information on HIV positive patients:
patients must give a signed statement requesting this.
61
Health Insurance Specialist – Roles and Responsibilities:
* Medical terminology
* Anatomy & physiology- important to recognize abnormal body conditions; every procedure or service reported to the insurance company must be linked to a condition that justifies the necessity for performing that procedure or service; Diagnosis and procedure coding conventions and rules
* Critical reading comprehension skills-
* Math skills to maintain patient financial records
* Excellent oral and written communication skills- be able to communicate both with patient and with insurance company
* Entering information into database
* Access information over the internet
62
Breach of Confidentiality:
o It is the unauthorized release of confidential patient information to a third party
o A contract is an agreement between two or more parties to perform specific services or duties
o A third party is one who has no binding interest in a specific contract
o Breach of confidentiality cannot be charged against a health care provider if written permission to release necessary medical information to an insurance company or other third party has been obtained from the patient, the parent, or the guardian
o A good maxim to follow is “When in doubt, have them write it out”
o To prevent breach of patient confidentiality, make sure each patient signs an “Authorization for the Release of Medical Information”
o Block 12 of the insurance form should either be signed or have the computer input automatically “signature on file”
o A new dated, signed release statement must be obtained yearly since they expire annually (undated signed forms are assumed to be in force until revoked by the patient or guardian)
o Always have patient sign a Release of general patient records before giving this information out to any Third Party
o Over the phone: “never give information over the phone or in person until you have verified that the party making the request is entitled to the information”
o Only give information to lawyers after the patient signs a record release.
o Only fax records when there is an urgent need or need immediate authorization; make sure the appropriate person is at the other end to receive it (there is also a confidentiality notice for faxes)
o Internet- no guarantee of confidentiality- If you are using or have DSL wireless service, be sure you apply a WEP (Wire Equivalent Privacy) Key to your system. This is a wireless Inscription Password which keeps other people around the area from using your service.
63
Insurance Fraud and Abuse:
* Fraud is “an intentional deception or misrepresentation that an individual makes, knowing it to be false, which could result in some unauthorized benefit”
* Insurance abuse is “incidents or practices of providers, physicians, or suppliers of services and equipment which, while not considered fraudulent, are not consistent with accepted sound medical, business, or fiscal practices”
* Health care fraud is “knowingly and willfully executing, or attempting to execute, a scheme or artifact to defraud any health care benefit program or to obtain, by false pretenses, representations or promises, any of the money or property owned by, or under the custody or control of, a health care benefit program”
64
Examples of fraud:
Using a higher level of service code
Billing for services or supplies never provided
Overutilization to increase revenue
65
Examples of abuse:
Excessive charges for services
Submitting claims for items not medically necessary
Improper billing to government when a third party is suppose to pay
66
Penalties:
Criminal or civil conviction through the federal court system to administrative and or monetary penalties levied by the Office of the Inspector General (OIG)
Penalties for submission of fraudulent claims are $10,000 for each instance and an additional assessment of up to triple the damages when an individual or entity does one of the following:
1. Presents a claim for an item or service that is based on a code that the person knows will result in greater payment to a person than the code the person knows is applicable to the service provided
2. Knowingly and willingly executes or attempts to execute a scheme to increase payments or benefits
67
OIG
Office of the Inspector General which inspects fraudulent claims.
68
Determining Coverage
The terms precertification, preauthorization, and predetermination refer to a patient’s eligibility for services.
69
Precertification
refers to the discovery as to whether a treatment (surgery, hospitalization, diagnostic test) is covered under the patient’s insurance contract. Will they cover these services?
70
Preauthorization
relates not only to whether the services are covered, but also whether the proposed treatment is medically necessary. Is this medially necessary?
71
Predetermination
refers to the discovery of the maximum amount of money that the carrier will pay for primary surgery, consultation service, postoperative care, etc. How much are they going to cover of the cost?
72
What is Insurance ?
protection against risk, loss or ruin by a contract in which an insurer or underwriter guarantees to pay a sum of money to the insured in the event of some contingency such as death, accident or illness, in return for the payment of a premium.
73
Primary & Secondary Coverage:
• Ask patients for insurance card and make copies of both front and back.
• Patients may have more than one insurance plan.
• Coordination of benefits:
o If a child is covered by both parents’ insurance, it will be necessary to determine who is considered the primary carrier (responsible for paying first) and who is the secondary carrier (pays last)
o Charges are filed with the primary first then after the claim has been processed and an EOB is received, the balance is submitted to the secondary carrier for payment.
74
Examples of insurances:
* Health
* Disability
* Liability
* Malpractice
* Property
* Life insurance
* Car insurance
* Pet insurance
* Renter’s insurance
* Theft identity insurance
75
Medical Care:
diagnostic and therapeutic measures provided by members of the health care team to persons who are sick, injured, or concerned about their health status
76
Preventive Services:
help individuals avoid health and injury problems; brings early detection of problems resulting in treatment options that are less drastic and less expensive.
77
Health Insurance:
contract between a policy holder and an insurance carrier or government program to reimburse the policy holder for all or a portion of the cost of medically necessary treatment or preventive care rendered by health care professionals.
78
Disability insurance:
reimbursement for income lost as a result of a temporary or permanent illness or injury; disability insurance generally does not pay for health care services, but provides the disabled person with financial assistance.
• Separate records are kept in the medical office
• Reimbursement given for
o Being unable to do regular work for certain number of days
o Was employed and has been loosing wages due to disability
o Person must remain under care to keep on receiving money
o Person will not receive disability if this happened while committing a crime which resulted in a felony; if they are in jail or stops seeing medical provider
79
Liability insurance:
a policy that covers losses to a third party caused by the insured, by an object owned by the insured, or on the premises owned by the insured; made to cover cost of medical care for traumatic injuries, lost wages, and many cases remuneration for the “pain and suffering” of the injured party
80
Automobile insurance:
is a contract between and individual and an insurance company whereby the individual pays a premium and, in exchange, the insurance company agrees to pay for specific car-related financial losses during the term of the policy.
• Collision: pays damage to covered vehicle caused by collision with another object or by an automobile accident
• A deductible is required with collision
• Comprehensive: covers damage from fire, flood, hail, impact with animals, theft, vandalism, or wind
• A deductible may apply
• Liability: pays for accidental bodily injury and property damage to others; this can include medical expenses, pain & suffering and lost wages.
• PIP: this stands for personal injury protection-reimburses medical expenses for covered individuals, regardless of fault, for treatment due to an auto accident; also pays for funeral, lost wages, rehabilitation
• Underinsured motorist: pays damages when a covered individual is injured in an automobile accident caused by another driver who has insufficient liability insurance
• Uninsured motorist: pays for damages when a covered person is injured in a car accident caused by a driver who does not have liability insurance
81
Major Developments in Health Insurance
* Started as contracts between isolated groups getting together to try to improve health care in their local communities (example: teachers from Texas who started “prepaid medical care arrangements” with hospitals
* Prepaid health plans were the forerunner of today’s health maintenance organizations (HMO) or managed care plans
82
Group practice:
as defined by the AMA- “three or more doctors joined together to deliver health care who agreed to make joint use of equipment, supplies and personnel, and divide income by a prearranged formula”
83
Procedural Terminology Coding:
* By mid 1950’s there was an increased demand for filing insurance claims which led to standardization of the procedural terminology reported on the claims.
* The use of computers led the medical community to develop a numerical coding system that could easily be entered into the computer
* By mid 1960’s some areas of the country had a procedural coding system in place
* The system was developed by the California Medical Society and thus became the prototype for the Physician’s Current Procedural Terminology (CPT) which is now used in this country
* Standardization of diagnostic data on claims submitted by physicians today was achieved by adopting a diagnosis coding system known as the International Classification of Diseases (ICD-9); this system was developed by the World Health Organization (WHO)
84
Time frames of sending claim insurances?
nsurance forms are filled out either manually or electronically.
the physician must sign the forms (except for Medicare claims filed by patients)
There are time limits to file claims. These vary from company to company.
Some insurers will not pay a claim unless it is filed within 6 months.
Medicare states that for services rendered from Jan. 1 to Sept. 30, claims
must be filed by Dec. 31 of the following year and for services
rendered from Oct. 1 - Dec. 31, claims must be filed no later than
Dec. 31 of the second year following the service.
Medicaid states that claims must be filed no later than 1 year from the date
of service.
85
Government-Sponsored Programs:
* Between 1965 and 1966 U.S. Congress enacted legislation to establish three government-sponsored health care programs: Medicare, Medicaid, and CHAMPUS (now known as TRICARE)
* Medicare: originally designed to cover individuals aged 65 or older and retired on either Social Security or the Railroad Retirement program
* Medicaid: jointly funded by state and local governments to provide health care benefits to indigent persons on welfare, the aged and/or disabled; some states have expanded this to cover other medically needy individuals who meet special state-determined criteria
* CHAMPUS: Civilian Health and Medical Program of the Uniformed Services; changed its name to TRICARE in the late 1990’s
86
Categories of Insurances:
1. government programs
2. Worker’s Compensation
3. liability plans
4. private or commercial (fee-for service plans) (PPO, POS)
5. prepaid health maintenance organization (HMO)
6. no insurance coverage- self pay
87
Fee-for-Service Plans:
* allow complete freedom in the choice of health care providers
* reimbursement is made either according to a set fee schedule or the usual and customary charges for a specific service in a given geographic region
88
Deductible:
Specified amount of annual out-of-pocket expenses for covered health care services the insured must pay to a health care provider before the insurer pays benefits
Coinsurance: specified percentage of each fee for a covered service the patient must pay to the provider
89
Copayment:
also known as copay; a stipulated fee paid for each visit or service
90
HMO Facts (read)
* lacked support from organized medicine
* attracted attention of general public due to lower premiums
* offered prepaid care at lower premiums than fee-for-service plans
* restrict health care to the HMO panel of participating providers
* require PCP (primary care physician) to preauthorize all services performed by specialists
* patient rarely pays a yearly deductible but may be responsible for a small copayment for each service rendered
* there are 4 major types: Staff, Group, Open-ended, and Point-of-service (POS)… complete coverage may or may not be paid by the employer
* In the 1960’s many studies were conducted by private agencies comparing the quality of care given by HMOs with the traditional care plans and they came to the conclusion that the quality of care was equal; after this, Congress encouraged the growth of HMOs
91
What is CHAMPVA?
* Civilian Health and Medical Program of the Veterans Administration
* Parallels TRICARE/CHAMPUS
* In 1977, there was a combination of Medicare and Medicaid programs which came under the administration of the Health Care Financing Administration (HCFA)
92
What is HCFA?
o Has authority to establish a new Medicare prospective payment system for hospital inpatient services
o Hospitals are paid a set amount for each person who falls into a diagnosis-related group known as the DRG rate
93
Procedural Coding:
* In 1984, HCFA began to require standardization of information submitted on Medicare claims (before, there were many systems)
* HCFA required the use of one standard claim form, known as the CMS 1500 form
* It also created the Health Care Financing Administration Common Procedure Coding System = HCPCS
* Adopted the AMA’s existing procedure code system officially titled Physician’s Current Procedural Terminology or CPT
* HCFA created a set of national and regional codes to cover services and reimbursement issues not addressed in CPT
* HCPCS codes were initially required on all Medicare and Medicaid claims, but then saw the value in the use of a standard national coding system and started using the CPT on all claims
94
Diagnosis Coding:
* In 1988, HCFA officially required the reporting of all diagnoses on claim forms using the WHO International Classification of Diseases
* The U.S. version is known as the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)
95
National Provider Identifier:
* Individual national identification numbers for all individual health care providers, group practices, and third-party payers of health insurance claims
* Must be used on all government claims
* Known as Provider Identifier (NPI)
* Payer number is the Payer Identifier (PAYERID)
96
Ambulatory Patient Classifications:
* APCs replace fee-for-service payments for outpatient services
* Prospective payments based on the procedures performed and the diagnoses established
97
Third party-reimbursement methods:
1. Capitation
2. fee-for-service
3. fee-for-service with utilization
4. episode of care
98
Capitation
* Used by HMO’s
* Pays provider fixed amount per capita (per person) based on contract
* Fee is independent of the number of services rendered to the enrolled patients
* Also called PMPM payment (per member per month payment)
99
Fee-for-service: (also called Indemnity Plans)
* Longstanding traditional form of reimbursement
* Can make appointment with almost any medical provider
* Services are itemized, priced, and charged to the patient’s account
* Payment for services made by patient or third party (insurance carrier)
* If the patient has met the deductible for the year, then the plan will pay a percentage of the bill- usually 80%. The patient pays 20%
* Few people purchase this traditional type of plan because it’s expensive
100
Fee-for-service with Utilization:
* Same as above with the addition of prospective and retrospective review of the health care provider’s treatment and/or discharge planning
* Designed to ensure the patient is given all necessary care in the most appropriate health care setting by the most cost effective method
* Employers can elect to retain the employee’s ability to choose health care providers
101
Episode of Care:
• Provider receives one lump sum for all services rendered to the patient for a specific illness
• Example: global surgical fee paid to physicians who perform major surgery
• Coverage: 1. Preoperative visit, 2. Surgery, 3. Normal postoperative care
**Complications are paid on a strict fee-for-service basis.
102
ICD 9:
nternational Classification of Diseases
Standardization of diagnostic data on claims submitted by physicians today was achieved by adopting a diagnosis coding system known as the International Classification of Diseases (ICD-9); this system was developed by the World Health Organization (WHO)
102
ICD 9:
nternational Classification of Diseases
Standardization of diagnostic data on claims submitted by physicians today was achieved by adopting a diagnosis coding system known as the International Classification of Diseases (ICD-9); this system was developed by the World Health Organization (WHO)
102
ICD 9:
nternational Classification of Diseases
Standardization of diagnostic data on claims submitted by physicians today was achieved by adopting a diagnosis coding system known as the International Classification of Diseases (ICD-9); this system was developed by the World Health Organization (WHO)
103
ICD 9:
nternational Classification of Diseases
Standardization of diagnostic data on claims submitted by physicians today was achieved by adopting a diagnosis coding system known as the International Classification of Diseases (ICD-9); this system was developed by the World Health Organization (WHO)
104
ICD 9:
nternational Classification of Diseases
Standardization of diagnostic data on claims submitted by physicians today was achieved by adopting a diagnosis coding system known as the International Classification of Diseases (ICD-9); this system was developed by the World Health Organization (WHO)
