Final answer:
The Medicare Coverage Database (MCD) and the Outpatient Code Editor (OCE) are software tools used in the healthcare industry to manage information and assist with compliant Medicare billing. These programs are part of the move toward more efficient healthcare systems, facilitated by rules set out by the ACA, including the transition to EMRs.
Step-by-step explanation:
The Medicare Coverage Database (MCD) and the Outpatient Code Editor (OCE) are examples of software for managing healthcare information and billing. These tools are particularly relevant in the context of Medicare billing and compliance. The MCD provides a comprehensive, searchable database containing all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), which stipulate whether Medicare will cover specific medical procedures or services. On the other hand, the OCE is used primarily for editing outpatient claim data to ensure correct billing. It checks services for compliance with the correct coding and billing rules prior to submission to the Medicare Administrative Contractor for payment.
The role of software like the MCD and OCE is to streamline the process of documentation and billing in healthcare, enhancing the accuracy and efficiency of medical coding and billing. As part of the broader push towards electronic medical records (EMRs) mandated by the Patient Protection and Affordable Care Act (ACA or Obamacare), these types of software support the transition to more efficient and cost-effective healthcare delivery systems. Healthcare professionals, including medical coders and billers, utilize these resources to ensure that patient care services are documented correctly and billed appropriately to Medicare.
To check your understanding, two locations where you would likely find an ICD code include medical laboratories (where tests are ordered and performed based on the ICD codes) and healthcare management systems (where treatments and laboratory work are verified for appropriateness).