...Design a Financial Policy Tamika Jones HCR 230 November 25, 2012 Beth Schalm Financial Policy It is great pleasure to us that you have chosen our medical facility to assist with your health care needs. Our medical office will be certain that you will have an healthy patient/physican relationship with both you and your family. To avoid any misunderstandings, it is important to you to be familiar with our financial policy. Feel free to ask any questions that you may have. Updating Information: It is to your responsibility to notify our receptionist of any changes that you are have made with your name, address, insurance and if you have recently changed phone number. It is important that our receptionist know the changes to your medical and financial information that’s on file. Insurance Policies: We are a part of most major insurance plans. The medical offices makes sure that they send out the patient bills to the insurance company’s so that the patient doesn’t have to have that responsibility. However, the office will need you to assist in any deductibles or copayments that you may have during the time of your appointment. The medical offices accept payments in Visa, MasterCard, Discover card, cash and money orders. You are responsible for any payments that your insurance company may not cover. Not all health care coverage is alike, and you need to know and understand your own company's policies on coverage and benefits...
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...Final Project Part B Kaitlyn Maness HCR230 My financial policy is best suited to my medical office because it is lenient but at the same time we expect a professional relationship to be maintained. I would never want anyone to walk into a doctor’s office and feel like they have no choices. We offer maximum care for an affordable price to everyone. Those who have no insurance can still be seen and not expected to pay an arm and a leg and those who can’t afford care are given an option. Our office would see all ages and all cases and offer some time of solution for payment. The basis of a strong medical office financial policy is an understanding between the medical office, the insurance company, and the patient. The medical office is responsible for verifying the patient’s coverage, verifying if a specific service is covered, and verify the co pay amount so it can be collected at the time of the visit or service. I think this is well outlined in our policy and should be understandable for the patient. The patient is responsible for paying their co pay at the time of the visit and paying any other balances then and there or within a reasonable time after they are billed. Our medical office staff will ensure that each patient is aware of our financial policies and how they affect them individually. If a member of the medical office staff does not enforce or explain the policies there will be repercussions. I will have our policies in at least 2 separate places...
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...Associate Level Material Appendix C Understanding Work-Related Injuries Case Studies: 1. Janet works as a branch manager for a large banking firm. Her job requires her to travel by personal vehicle to different branch offices several times each week. Janet has lower back problems from a result of a skiing accident many years ago, which is further aggravated by long periods of sitting while driving. Janet was returning from the branch office to the home office on Thursday afternoon when another driver struck her car from behind. A physician examined Janet and determined that the accident aggravated her pre-existing back injury. The physician ordered Janet to remain off work for at least two weeks. a. Is this injury covered under workers’ compensation? Yes b. Rationale for your decision: Although Janet had a pre-existing back injury; it was re-aggravated by the long periods of sitting and getting into an accident while traveling for her job. c. If covered, identify the appropriate injury category: Injury with medical and disability benefits 2. Frank works as a clerk in a local convenience store with a non-smoking policy. On a personal work break, Frank stepped outside the building to smoke a cigarette. As Frank walked across the parking lot, he slipped on a patch of ice and fell, breaking his wrist and injuring his outstretched hand. a. Is this injury covered under workers’ compensation? Yes b. Rationale for your decision: His injury...
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...Fairview Medical Associates Financial Policy In an attempt to keep your medical cost for services to a minimum, we have adopted the following policy regarding payments and billing. If you do not have insurance coverage, payment will be due in full amount on the day the service is giving. Copayments and Deductibles You are expected to pay your copayments and deductibles at the time of service. All payments are required at the time of service unless other arrangements have been made in advance. Fairview Medical Associates accepts cash, personal checks (in-state only), VISA, and MasterCard. There is a service charge of $25.oo for any returned check (Smith, 2009). Past Due Balances ALL ACCOUNTS MUST BE PAID IN FULL WITHIN NINETY (90) DAYS from the date of service or payment arrangements need to be arranged before medical service can be provided (Valerius, 2008). The unpaid balance is your responsibility and must be paid. We will submit your insurance claim to your Primary Insurance Companies as a courtesy to you (Valerius, 2008). After the 90 days, you outstanding balance is due regardless of your insurance claim status. If the process of filing the claim is delayed we request that you assist us in concluding the process (Valerius, 2008). Arrangements need to be made before the 90 days from the date of service .Consecutive payments are to be made in order to continue to have medical services provided by Fairview Medical Associates. Noncovered Services If you are unsure...
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...HCR 230 Week 9 Final Project Design a Financial Policy To Buy This material Click below link http://www.uoptutors.com/HCR-230/HCR-230-Week-9-Final-Project-Design-a-Financial-Policy Resources: Appendix A and Figure 15.1 on p. 487 of Medical Insurance Complete Part A and Part B of your final project using critical thinking skills. These skills include suspending judgment and applying problem-solving skills and methods while conducting research. You must form evaluative decisions and provide your rationale after considering how you would design a medical office financial policy. Decide on the type of medical office setting you prefer to research. Focus on that setting as you complete each portion of the final project. Refer to Figure 15.1 on p. 487 of your textbook, the Internet, and the University Library as resources. Search for medical office financial policy advice and sample policies. Write an original 750- to 1,050-word medical office financial policy for Part A of your final project. In your policy, provide a minimum of three references other than your textbook, formatted according to APA standards. Include the following components in your policy: · Collection of copayments, deductibles, and past-due balances · Arrangements for handling of unpaid balances · Handling of payments for noncovered services · Prepayment policies · Policies for accepting cash, checks, money orders, and credit or debit cards · Arrangements...
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...HCR 230 Week 9 Final Design a Financial Policy Part A&B Get Tutorial by Clicking on the link below or Copy Paste Link in Your Browser https://hwguiders.com/downloads/hcr-230-week-9-final-design-financial-policy-part-ab/ For More Courses and Exams use this form ( http://hwguiders.com/contact-us/ ) Feel Free to Search your Class through Our Product Categories or From Our Search Bar (http://hwguiders.com/ ) FINANCIAL POLICY, PART “A” Financial Policy We always try to keep medical services costs reasonable and you can help us in great deal by eliminating the need for us to bill you. The following is a summary of our payment policy. All Payments is Expected at the Time of Service: All the payments are required at the time services are rendered unless some other payment arrangements have been made in advance. This includes applicable coinsurance and copayments for participating insurance companies. The XYZ Medical Practice accepts cash, personal check (in United State only), VISA, and MasterCard. There is a service charge for any returned check. The patients who have an outstanding balance of 60 days past due must make arrangements for payment before scheduling an appointment. We understand that some people have financial difficulty; therefore, we may advise them that they seek their child’s immunization through a clinic or health bureau. Insurance: We bill participating insurance companies as a courtesy to you. You are expected to pay your deductible and copayments...
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...HCR 230 Week 1 Assignment Features of Private Payers and Consumer Driven Health Plans Get Tutorial by Clicking on the link below or Copy Paste Link in Your Browser https://hwguiders.com/downloads/hcr-230-week-1-assignment-features-private-payers-consumer-driven-health-plans/ For More Courses and Exams use this form ( http://hwguiders.com/contact-us/ ) Feel Free to Search your Class through Our Product Categories or From Our Search Bar (http://hwguiders.com/ ) Features of Private Payer and Consumer-Driven Health Plans PPOs will pay participating contributors established on a discount from their physician fee schedules, called discounted fee-for-service. Under the PPO’s, the patient has to pay an annual premium and frequently a deductible. A PPO plan may propose either a lower deductible with a higher insurance payment or a high deductible with a lower premium. Covered members remit a copayment at the time of each medical service. Each individual may also have a per annual deductible to pay out-of-pocket. A patient may see an out-of-network doctor requiring a referral or preauthorization, but the deductible for out-of-network services may be higher, and the percentage plan will pay may be lower (Valerius, Bayes, Newby, Seggern, 2008). Healthcare organizations were initially intended to protect all basic services for an annual premium and visit copayments. This contract is called “first-dollar coverage” considering that no deductible is needed and patients do not...
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...Adjudication Process Tamara Hurley HCR/230 February 19th, 2014 Jill Frawley Adjudication Process There are five steps in the claims adjudication process. Each of these five steps serves the purpose of making sure that a claim is processed properly without any mistakes. Step one is the initial process, in this step most of the simple errors are fixed or caught. Some examples would be the patients name, the diagnose code may not match up with the date of service, or even have the wrong plan identification number. A claim with even one mistake will be rejected, this means that the claim will be sent back to the provider to correct the errors and resubmit the claim. The next step would be the automated review. Here a claim is reviewed for time limits of the claims filed, the benefits that the patient would be eligible for, referral forms, and if they received preauthorization for services. At this stage the claim is also checked for non-covered services, duplicate dates for services, utilization and medical review. If there are problems found in this step than the process on the claim is stopped until it can be reviewed manually. Any information still needed is requested during this review, this will ensure that the claim can be processed. When every mistake or problem has been fixed and handled than the claim will enter the determination process. The determination of if the claim will denied, paid, or have the payment reduced. After all of this than the claim...
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...Ramifications of Participation Contracts Emella Steele HCR 230 October 18, 2014 Myrnell Martin Ramifications of Participation Contracts Participation contracts are created that would allow the providers to have an overview of a plan to make a decision on if they will participate in the plan or not. The providers use the plan to see if participation would benefit them financially. An introductory section, the purpose of the contract, services that are covered, responsibilities of physician, obligations of the managed care plan, compensation, and billing guidelines this is how the plan is broken down into parts. What the plan pays, the physician fees are typically higher. The provider may still experience less revenue because the plan brings in more patient, providers also check to see if the plans protocols hinder their judgment in what treatment they give the patient. They can get more exposure, depending on the plans the providers participate with because some plans want the physician name to be advertise through the newspaper, radio, and television. It could increase the revenue for them because this would be an extra benefit to the provider. With a fee-for-service plan, the main problem is preventive care not covered. The patient can see any provider that they would like to visit. The providers are paid for all test and procedure on the patient, and this is another benefit. The most usual or common charges for these procedures and how often the procedure is performed...
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...Ramifications Participation Contracts Stientje Charette HCR/230 4/26/14 Myrnell Martin Ramifications Participation Contracts Participation contracts can represent financial opportunities in many ways for providers as these contracts define what the providers’ responsibilities are within the medical relationship. Though one may argue that providers can only benefit from participation contracts when the insurer does not require write offs however, there are other financial opportunities such as increased revenue through advertisement and a gain of new patients associated with the insurers. When a provider is associated with a certain plan, this association can is made known through television commercials, radio announcements, and word of mouth regarding the practice’s participation list, which can increase the provider’s revenue and number of patients. Though there are several financial opportunities available for provider who chooses to participate with certain insurers, the providers are also at risk of losing money or settling for less revenue because the insurers will more likely than not pay less than the provider’s scheduled fees. Prior to joining any plan a provider has the choice to review several plans before making a decision. This allows the provider to choose a plan that meets his or her practice and financial needs. As with any arrangement there are positive and negative ramifications associated with it and discounted fee-for-service arrangements are no different...
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...Characteristics of Workers’ Compensation Plans University of Phoenix FOOTING THE BILL HCR 230 Barbara Hopkins July 12, 2013 Workers’ compensation was developed to benefit both the employer and the employees. It provides employees who are injured on the job with compensation for their injuries, and it protects employers from liability for employees’ injuries (Valerius J., Bayes..L.N., Newby.C., Blochowiak. L. A., 2014,). Work-related illnesses or injuries suffered by civilian employees of federal agencies, Including occupational diseases they acquire are covered under various programs administered by the Office of Workers’ Compensation Programs. OWCP is part of the U.S. Department of Labor (Valerius J., Bayes..L.N., Newby.C., Blochowiak. L. A., 2014,). The four workers’ compensation plans that provide coverage to federal government employees are: 1. The Federal Employees’ Compensation Program 2. The Longshore and Harbor Workers’ Compensation Program 3. The Federal Black Lung Program 4. The Energy Employees Occupational Illness Compensation Program States provide two types of workers’ compensation benefits .One pays the worker’s medical expenses that result from work-related illness or Injury. The other pays for lost wages while the worker is unable to return to work. In some states, state benefits just won't be enough to help an injured or ill worker to survive...
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...“Effective Financial Policies and Procedures” By: Khay Fernandez HCR 230 Jetonga Keel 11/30/2014 Financial policies and procedures are important to the running of a medical office; this means that all procedures must be done correctly to ensure that the laws are upheld. If these procedures are not followed then there are many consequences that could arise that will injure the integrity of the medical office. There are a few basic elements that are needed to ensure that the medical office is using an effective financial policy. This policy is generally the same as any other business, for example there are accounts receivable, payable, supplies that are ordered, and collections. There are accounts that need to be paid by the patients that if are not paid would than go to the collections department to ensure that the patient pays the money that they owe. If these patients have insurance than these bills or “claims” are sent to their perspective insurance companies. Payable accounts are actual bills that the medical office owes, such as electric bills and payroll. Financial policy depends on the insurance company as well as the medical offices, for example if it is financial policy for the medical office to charge a fee for a patient that is a no show than that is policy and the patient will have to pay the set amount. Each medical office has the right to make their own policies when it comes to financial obligations. Each patient is made aware of the policies before...
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...Characteristics of Workers’ Compensation Plans By Vershawn Thompson February 7, 2013 HCR/230 Jill Frawley There are currently two types of state workers compensation benefit plans as well as four different types of federal plans. One of the state workers compensation plans consists of paying for medical expenses. This program allows compensation for the employee if their injury or illness was caused by their employment. The second plan offers compensation for the employee’s wages that are lost during the time the employee is physically unable to work. The state workers’ compensation fund puts premiums into one state based insurance fund. This fund is the source of payment for all claims. In the private plan—which is favored by most employers—employers enter into contracts with private insurance carriers. One of the four federal compensation plans is the Longshore and Harbor Workers’ Compensation Program. This program offers individuals that are working in the maritime industry some coverage. People that develop certain diseases like cancer because of exposure to radiation while working at federally-owned facilities where radioactive materials are accessible are covered under the Energy Employees’ Occupational Illness Compensation Program. Employees of the federal government are eligible for coverage under the Federal Employees’ Program. The Federal Black Lung Program was established...
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...Final Project Financial Policy Part A Tracie Blakeslee HCR/230 November 3, 2013 Santresa Sanders NEWFIELD FAMILY MEDICAL PRACTICE FINANCIAL POLICY Here at Newfield Family Medical Practice our main objective is to provide the highest quality of healthcare and to try and keep the cost of medical care down. For us here at Newfield Family Medical Practice to achieve these you as our patient need to understand our financial policy. Please read this carefully and if you have any questions, please speak to any member of our staff (“American Academy of Pediatrics”, 2013). 1. On arrival please come to the receptionist desk and check in with the front end staff, present them with your current insurance card, you will be asked for it at every visit, inform the front end staff of any changes that have been made such as name change, address, telephone, emergency contact person, or insurance provider. You will be asked to sign in once all information has been verified. IF THE INSURANCE CARD YOU PROVIDE IS NOT CORRECT, YOU WILL BE RESPONISBLE FOR PAYMENT FOR MEDICAL SERVICES FOR THE VISIT, AND WILL BE RESPONSIBLE TO FILE A CLAIM WITH THE CORRECT INSUANCE PROVIDER. 2. Newfield Family Medical Practice must appear on your insurance card if we are your primary care provider, if your insurance company has not been notified that we are your provider on the date of your appointment, you may be financially responsible for the visit (“American Academy of Pediatrics”, 2013). 3....
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