Question

Billing and Coding

Analyze any limitations of the NPDB.

Describe how NPDB relates to billing for services

Answer 1

1. BILLING AND CODING:-
(A) BILLING:-it refers taking information by billers from the medical coder and make a bill for the insurance company, called a claim.
-billing includes-
        doctor’s diagnosis
        doctor's prescription etc.
(B) CODING:- it refers to taking something by coders that’s written one way.
-Example- doctor’s diagnosis
                     Prescription
      and translate it in a numeric or alphanumeric code.

2. NPDB:-(NATIONAL PRACTITIONER DATA BANK):-
- It was established by the Health Care Quality Improvement Act, 1986.
- it restrict the ability of doctors to move their practices from one state to another without disclosing previous unprofessional or incompetent conduct.
- NPDB collects and maintain information reports on-
      Medical malpracticectice payments
      Federal and state licensure actions
      Adverse clinical privileges actions
Limitations:-
-Data include reports for the many States, but not include all over country.
- limitations also exist for various practitioner types based on the historical data reporting requirements.
- Data are based on the most recent calendar year processed by NPDB for report purposes.

3. NPDB and billing:-

-NPDB does not receive federal funding to support its operations.
-According to federal law the fees charged by the NPDB must cover the cost of operations.
-NPDB charge according to the type of query as continuous or one time.