Prepare examples of various coding and billing issues you have experienced in clinic settings especially in Peds and women’s health
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Skill
Professional
Proficient
Developing
Incomplete
Comments
SCORE
25
22
19
17
PHOTO
(10)
Business Professional Headshot or other
appropriate to industry.
Business Professional Headshot.
Picture is casual in nature.
Picture is missing.
Headshot is not blurred and clearly shows face.
May include more than
headshot.
A group shot or other
individual is included in photo.
Distracting background.
A plain backdrop is used.
Clothing is not
appropriate to industry.
Quality of Photo is lacking, e.g. focus,
contrast etc.
HEADLINE
(10)
Brief, informative and use of keywords, skills, or interests that relate to the industry or related career goals and/or interests
Connects current position to career goals
Brief, informative and use of keywords, skills, or interests
Does not related to career goals and/or interests
Default to Current Title and Organization
Default of Student at Florida National University
Thoughtfully considered use of default
Default of Student at Florida National University or Current position unrelated to career goals
SUMMARY
(10)
Describes current status, relevant skills, interests, coursework or experiential experiences e.g., internships, student leadership roles, campus activities etc.
Describes current status, skills and interests
Career goals or interests may not be evident
Describes academics, skills and activities
List of skills without validating experience
Summary is missing
Connects background to position, goals or industry of interest
Concise and confident manner
Use of action words, job or industry specific key
Words
EDUCATION
(Includes: School, Dates Attended, Degree, Field of Study, and Activities and Societies.
GPA optional
(10)
All appropriate information included.
Presented in a balanced manner
All appropriate information is included with 1-2 incorrect items. (ex: abbreviations)
1-2 pieces of content missing.
3+ pieces of content are missing.
Skill
Professional
Proficient
Developing
Incomplete
Comments
DESCRIBED EXPERIENCE
(any work and/or activities with bullet points to describe tasks and accomplishments or summary narrative of experience)
(10)
All appropriate information included (Company Name/Organization Name, Title, Location, Time Period, and Description.)
Statements clearly describe tasks and duties of position.
Action statements demonstrate a variety of transferrable skills.
All appropriate information included with 1-2 incorrect items (ex: abbreviations)
Statements clearly describe tasks and duties of position.
Action statements demonstrate some transferrable skills.
1-2 pieces of content missing
Statements could more clearly describe tasks and duties of position.
Action statements do not demonstrate transferrable skills.
3+ pieces of content are missing
Statements do not describe tasks and duties of position.
There are no action statements utilized and it is difficult to discern transferrable skills.
Accomplishments / results quantified where appropriate.
Accomplishments / results are not quantified where appropriate.
Accomplishments / results are not quantified where appropriate.
Accomplishments / results are not quantified where appropriate.
SKILLS & EXPERTISE
(10)
5+ relevant pieces of information is given to further validate skills, interests and abilities
3-4 relevant pieces of information given to further validate skills, interests and abilities
1-2 relevant pieces of information given to further validate skills, interests and abilities
No relevant pieces of information given to further validate skills, interests and abilities
(courses, honors and
awards, skills and
endorsements,
organizations,
volunteer,
recommendations,
groups, endorsements
etc.)
RECOMMENDATIONS
(10)
1 or more professional recommendations/references listed
1 professional recommendation/reference listed
1 personal recommendation/reference listed
Recommendation/reference is missing
LOCATION/INDUSTRY & PROFESSIONAL LANGUAGE
(10)
Location and industry both clearly identified on profile
Positive, engaging, and enthusiastic language throughout profile that helps demonstrate the writer’s achievements.
Action verbs are varied, and well-chosen to demonstrate tasks, duties, transferrable skills and accomplishments related to career goals.
Only location or industry listed and clearly identified on profile
Language is neutral throughout profile
Action verbs are varied, yet the selection is conventional or homogenous. Not offering much space to describe tasks, duties, transferable skills and accomplishments in a detailed way.
Location and industry not clearly identified on profile
Language is neutral throughout profile
Action verbs are not varied.
Location and industry are missing
Language is negative throughout profile
Action verbs are not varied.
No negative or unprofessional content is expressed
No negative or unprofessional content is expressed
1-2 negative or unprofessional content is expressed
3+ unprofessional content expressed
UNIQUE URL
(10)
Unique and professional URL created
Professional URL created but lacks unique quality
Unprofessional URL
URL missing
GET CONNECTED
(5)
1 or more professional groups joined
At least one professional group joined
1 non-professional group joined
Professional group missing
SPELLING / GRAMMAR
(5)
No errors in spelling, grammar, verb tense,
personal pronouns, and/or
1-2 errors in spelling, grammar, verb tense,
personal pronouns,
3-4 errors in spelling, grammar, verb tense,
personal pronouns,
5+ errors in spelling, grammar, verb tense,
personal pronouns,
punctuation.
and/or punctuation.
and/or punctuation.
and/or punctuation.
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Expert Solution Preview
One of the coding and billing issues that I have experienced in a clinic setting, particularly in Pediatrics, is the incorrect coding of well-child visits. Many times, the providers fail to properly document and code for the appropriate age and complexity of the visit. This can result in undercoding, leading to potential missed revenue for the practice, or overcoding, which can lead to audits and financial penalties.
In Women’s Health, a common coding issue that arises is the incorrect use of modifier -25. This modifier is used to indicate that a significant, separately identifiable evaluation and management (E&M) service was performed on the same day as a procedure. However, some providers mistakenly apply this modifier for every office visit, resulting in inappropriate billing and potential audits.
Another coding issue commonly observed in Women’s Health is the proper use of diagnosis codes for prenatal care visits. Providers may sometimes use general codes or fail to update the codes as the pregnancy progresses, leading to inadequate reimbursement and inaccurate documentation of the patient’s pregnancy status.
Additionally, there can be challenges with billing for preventive services and screenings in both Pediatrics and Women’s Health. Providers may overlook documenting the specific preventive service performed or fail to use the appropriate diagnosis code, resulting in denied claims and missed opportunities for early detection and prevention.
These examples highlight the importance of accurate and thorough documentation, proper coding, and adherence to billing guidelines in clinical settings, especially in Pediatrics and Women’s Health. Educational initiatives and regular audits can help address these issues and ensure compliance with coding and billing requirements.
