...Lisa Collins Instructor: Mrs. Donna Purvis, MBA HLTH245 Principles of Reimbursement Management September 29, 2015 Ten Step Billing Process The ten steps of the medical billing process have been divided into three categories: The visit, the claim and the post claim. Following the billing steps to complete correct claims ensures that providers are paid accurately and timely for services and procedures. The Billing process begins with the preregistration of patients. Collecting personal, basic demographic information, and insurance information and entering that information into the database. All of this personal information can be referred to at any time during the medical billing process. Keeping up to date patient and insurance information makes patient check in more efficient and eliminated potential billing errors. Confirming financial responsibility is the next step in the billing process. Once a patient’s information has been updated in the computer system it is then the medical staffs’ responsibility to determine who will be paying for the services rendered for the appointment. Insurance providers are contacted and benefits are verified as different plans have different levels of coverage. Once the medical staff is aware of what the allowable insurance benefits are, contact with the patient should be made so the patient is aware of their responsibility for out of pocket, non-covered expenses, co-payments, and deductibles. During the appointment, the physician...
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...Executive summary 4 Industry Analysis 5 Mission Statement 6 Growth Plans/Goals 8 Benefits of the Business 9 Business Models 10 Services 11 Market 13 Competitors and website evaluation 15 Operations 16 Operation Plan 17 Financial Statements 20 Appendices Executive Summary The U.S. Government has emphasized EMR (electronic medical records) and ECS (electronic claims system) as an answer to reducing the costs attached to patient care. In addition, electronic systems help in expediting reimbursement of insurance claims. Yet, it is still difficult to perform this task. Currently more than 60 percent of all medical claims in the U.S. are mailed. Submission of paper claims dates back in the U.S. to the early 1950’s. One of the primary reasons for not implementing a new system is the cost of new EMR and ECS systems. In 1990, the federal government mandated that physicians start submitting their claims electronically. This standard only applies to large practitioners and “small” providers can request a waiver from submitting claims electronically. This waiver was established when the government recognized the financial burden new electronic systems could have on small providers. Small providers, however, are losing money due to the inability to access current technology. Mount Brighton is an affordable medical management company that can perform the electronic claims processing for both small and big providers. Mount Brighton is efficient and effective...
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...Electronic Media Claim (EMC): this is an electronically processed and transmitted claim. The claim process starts by the healthcare facility collecting information, such as, the patient’s condition, the physician’s diagnosis and a list of all procedures performed. This information is then sent to the insurance company. Healthcare facilities that submit electronic claims use a clearinghouse. Clearinghouse: a clearinghouse acts as a third person that takes claims information from a healthcare facility and sends it to the insurance company. The clearinghouse checks the claims for errors and also makes sure that procedures and diagnosis are coded correctly. Explanation of Benefits (EOB): a document that is sent to patients from the insurance company explaining what services where paid for by the insurance company. An Explanation of Benefits usually includes, patient’s name, patient’s insurance ID number, claim number, provider information, type of service, date or service, charges, total patient cost and the amount the patient is responsible for paying. Bucket Billing: in bucket billing the healthcare facility decides how much to charge for a procedure, the insurance company reimburses the healthcare facility for that procedure and if that reimbursement does not cover the full bill, what is left over is then billed to the patient. That is called bucket billing. Benefit of Using Electronic Claims Clearinghouses Using an electronic claims clearinghouse have a lot of...
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...Public healthcare services are administered by different regulatory authorities in the United Arab Emirates. The Ministry of Health, Health Authority-Abu Dhabi (HAAD), the Dubai Health Authority (DHA) and the Emirates Health Authority (EHA) are the main authorities. Ministry of Health and Emirates Health Authority The Ministry administers a number of federal healthcare laws, including (i) Federal Law No. 5 of 1984 (regulating the licensing and registration of physicians, pharmacists and other healthcare specialists within both public and private healthcare establishments); (ii) Federal Law No. 7 of 1975 and Federal Law No. 2 of 1996 (defining the specific requirements for establishment and licensing of public and private medical laboratories, clinics and hospitals in the UAE); and (iii) Federal Law No. 4 of 1983 (governing pharmaceutical professions and establishments and the import, manufacture and distribution of pharmaceutical products). The Ministry oversees the Northern Emirates healthcare system (the Northern Emirates include Ras Al Khaimah, Ajman, Umm al Quwain, Sharjah and Fujairah). Some of the Northern Emirates recently started establishing new healthcare institutions or reforming existing ones. Sharjah, for example, established the Sharjah Health Authority by Sharjah Amiri Decree No. 12 of 2010. The Ministry, however, still invests substantial efforts to improve the level of healthcare services in the Northern Emirates. The projects announced...
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...patient statements Check in patients Monitor payer adjudication Review coding compliance St ep 8 S te Check out patients Review billing compliance p7 St ep 5 S tep 6 Learning Outcomes After studying this chapter, you should be able to: 1.1 Explain how healthy practice finances depend on correctly accomplishing administrative tasks in the medical office. 1.2 Compare coinsurance and copayment requirements for health Copyright © 2014 The McGraw-Hill Companies plan benefits. 1.3 Identify the key steps in the medical billing cycle. 1.4 Discuss the impact of electronic health records on clinical and billing workflow. 1.5 Evaluate the importance of professional certification and of medical liability insurance for career advancement. S te p4 Medical Billing Cycle Prepare and transmit claims 1 accounts payable (AP) accounts receivable (AR) benefits cash flow certification coding coinsurance copayment covered services deductible diagnosis documentation electronic claim (e-claim) electronic health record (EHR) fee-for-service health care claim health information technology (HIT) health plan indemnity plan managed care managed care organization (MCO) medical assistant medical billing cycle medical documentation and billing cycle medical insurance medically necessary noncovered (excluded) services out-of-pocket PM/EHR policyholder practice management program (PMP) preauthorization...
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...Deborah Bennett 01/22/2013 HCA 240 Instructor Moiz Lalani Electronic Medical Records from a Business Perspective In this paper we shall analyze how Electronic Medical Records (EMR) impacts health care organizations from a business perspective, as well as how it may impact profit organizations (versus non-profit organizations) differently. In addition we shall discuss perspectives and responsibilities of the financial management staff, and the basic rules and regulations involved with EMR in which the health care financial management of the organization must address. Starting around 1991 the Institute of Medicine (IOM), known to be the leading innovators concerning medical advances, started encouraging those in the health care delivery system to see the future and accept it, by beginning preparation for instituting electronic medical records. Expounding on the many advantages EMRs would allow facilities and physicians alike; such as, providing for more efficiency, through instant access of a patient’s health history (including all labs, tests and meds prescribed by all doctors for the patient) that is stored on the computer and can be accessed throughout the country, and eventually the world. In turn this would also provide for more effective and less redundant care, and with certain software installed for guiding diagnosis and medicine interactions, could also promote error free treatment and care, avoiding life-threatening episodes in this regard (Haupt, 2011)...
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...Michelle Lee Marketing 489 Th 16:00-18:45 February 19, 2015 Fiserv Takes on the E-Billing Market I. Summary of Facts A. Market – Financial services data processing industry 1. Fiserv acquired “CheckFree”, the market-leading electronic billing and payment pioneer in 2007 2. 70% of online households use electronic bill payments, but less than 20% regularly use e-billing technology to view their bills 3. 86 million out of 118 million are online receiving 10 bills per month 4. Electronic bill payments gaining wider acceptance 5. Competitors: IBM, Microsoft, First Data, and Citibank 6. Economic Market - Oligopoly B. Product 1. Used by utility companies, cable/satellite TV providers, and financial services firms 2. “Outgoing” interactions assist indirect customers to pay bills electronically 3. “Incoming” interactions assist consumers to receive bills online electronically 4. Allow consumers to receive and view e-bills at a biller’s Web site 5. US market leader in core processing services and largest independent US check processor 6. Leading US Internet banking services provider and leader in bill payment and presentment services in Dec 2007 7. Benefits a. Core- Ease of and efficiency financial transactions b. Secondary 1) Penetration was driven by convenience in 2009 2) Savings on postage stamps 3) Improved perceptions of payment security 4) Ease of access to bills 5) Reduces clutter 6) Saves paper, saving trees 8. Product Life Cycle: Growth/Maturity ...
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...Course Project Compare & Discuss Electronic Software for Health Records MediTouch EHR Electronic Health Record Software HSM 330: Health Services Information Systems Devry University September 12, 2013 Compare & Discuss Electronic Software for Health Records An electronic health record or EHR is a concept defined as a collection of electronic health information about individual patients or populations. Once an EHR system is installed and staff are trained in its proper use, retrieving and updating patient clinical records is performed substantially faster and with fewer errors. In most cases, this allows health care providers to finish patient charting more quickly, and to do so while with the patient, increasing accuracy and completeness of the record. This can result in an increase in scheduled visits per hour with no lessoning of patient care quality. Also, by reducing the burden of administrative work, it allows a healthcare provider to concentrate more on the patient and less on paperwork. By definition, an EHR system is a record in digital format that is capable of being shared across different health care settings. In some cases this sharing can occur by way of network-connected, enterprise-wide information systems and other information networks or exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics...
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...management system captures billing data, patient demographic information, strategic reports, and appointment scheduling. The HITECH Act of 2009 requires that patient demographics, as well as disease data, are collected and reported to federal and state health agencies in electronic format (CDC, 2012). As a result, our practice has made the decision to invest in the purchase and implementation of the Greenway Health practice management system. The purpose of this paper is to provide background on the system, identify the management and organizational goals for selecting this system, the benefits to the organization, and the justification for this capital investment. Greenway Health Practice Management As a web-based application, the Greenway Practice Management system has been selected as the preferred solution because of its ability to verify benefits eligibility for patients, manage patient scheduling and patient billing. The application will streamline the billing process for the multiple office locations in our practice, allowing for centralized management. A primary feature of the Greenway Health Practice Management system is its commitment to interoperability. As Tee Green CEO of Greenway, “if we’re truly going to improve health, we’re going to need to start connecting provider and consumer information with clinical research” (Jayanthi, 2014). The interoperability of Greenway will allow our practice to pull demographic, billing, and scheduling data in combination...
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...Patients may obtain more than one medical insurance policy. Coordination of Benefits provisions of the policy or plan determines which plan is primary. The primary plan’s benefits are applied to the claim first. The unpaid balance is usually paid by the secondary plan to the limit of responsibility. Once a patient has completed his/her encounter forms and is seen by the physician; the patient’s information is ready for the billing process. The insurance billing specialist identifies the insurance company that is billed first. Once the primary payer has paid its responsible portion, the claim is submitted to the secondary payer. Insurance benefits must be coordinated so the total amount paid does not exceed 100% of the charges. Primary and secondary payer for...
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...EHR selection and decision-making process An electronic health record or EHR is a concept defined as a collection of electronic health information about individual patients or populations. Once an EHR system is installed and staff are trained in its proper use, retrieving and updating patient clinical records is performed substantially faster and with fewer errors. In most cases, this allows health care providers to finish patient charting more quickly, and to do so while with the patient, increasing accuracy and completeness of the record. This can result in an increase in scheduled visits per hour with no lessoning of patient care quality. Also, by reducing the burden of administrative work, it allows a healthcare provider to concentrate more on the patient and less on paperwork. By definition, an EHR system is a record in digital format that is capable of being shared across different health care settings. In some cases this sharing can occur by way of network-connected, enterprise-wide information systems and other information networks or exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information. There is much variety of health record software available for medical records. Sharing patient charts and medical information with other health care providers is also made substantially...
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...Medicare Exhaust Billing Procedure Manual Project Cynthia Gause Colorado Technical University Online ENGL205-1301 Technical Writing and Speaking Phase 4IP Contents Contents 1 Phase 1 IP 2 Procedure Manual Outline 2 Phase 2 IP 3 Procedure Manual Proposal (Revised) 3 Brochure 4 Brochure Continued 5 Phase 3 IP 6 Medicare Exhaust Billing Checklist 6 Procedure Manual 7 Preparing Bill 3 Step I – Census 3 Step II – Bill Upload 4 Exhaust Billing Claim Coding 5 Step III- Xclaim 5 DDE Step IV 7 Secondary Claim Submission 8 How to submit Secondary Exhaust Claim 8 UB04 Claim examples 8 Billing Reference Tools 10 Type of Bills 11 Patient Status Codes 12 DDE Access/ Menu 13 Phase 1 IP Procedure Manual Outline Outline for Medicare Exhaust Billing Procedure Manual I. Introduction This section will provide an overview of Medicare exhaust billing and the purpose of this manual. II. Bill Uploads Upload bill and billing data in the Ram system to allow bills to be created. III. Claim Coding, and required remarks Once bills have been uploaded and created, bills need to be coded correctly and remarks need to be added to the claim. IV. Submit Bill to Medicare thru Xclaim...
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...Electronic Medical Records Software HCR101 The major feature of having an EMRS (electronic medical records software) in your medical facility is that it is right at your fingertips and much less paper work to complete, everything is done on the computer and all important demographic patient information ,including patient care ,physician and prescription is kept in a computerized data base file system. The other benefits for the patients is improved treatment and diagnose, significant fewer errors found in patients’ health records and quicker decision making and faster care for all your medical staff. The other benefits for your medical office and their medical team of professionals is that they have the ability to quickly transfer patients data from one department to the next department, this program saves time and a great deal of space, more time and ability to increase the number of patients that are seen by a facility in return this increases workflow and productivity. It also helps improve the reductions of errors within the medical facility, helps to reduce the costs of overtime labor expense and transcripts services. The EMR software program can customize your electronic records to grow with your medical facility, clinical documentation capabilities and ability to process patient’s records in a much more organized accurate and efficient time for billing purposes. The importance of practice management is to eliminate error and save time and cost...
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...Billing Memo This memo is to remind the office of the important of documentation of coding and coding. If something has not been documented it does not happen then we can’t be billed for those services. There are minimum documentation requirements that are needed for reimbursement. Within documentation there are general principles that comes along with documentation. They are as followed chief complain of the patient on their time of visit. A relevant history of the patient. If any physical exam were done to that patient at the time of visit. Those findings with need to have documentation. Any diagnostic testing that has been order by the provider. The reason why the testing was of medical necessity. There also needs to be documentation of the assement of the patient. As well as if a form of diagnosis has been given by the provider to the patient. A plan of care is also needed for documentation and any recommendation of care. Along with the length of the visit with the health care provider. If counseling and or coordination have been provided to the patient. The finally requirement for reimbursement is the date of service that the patient was seen by the provider. As well as the legible identify of the health care provider. Along with those requirements I would to inform you of the electronic solutions that exist that can help ensure. Accurate evaluation and management coding with in our office. The first solution is the use of an electronic superbill. It’s of great important...
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...Information Technology Management: Unification of the actual and future information systems used by Incodepf and the new global innovations in technology Karen Lorena Ospina Hidalgo Managerial Applications of Information Technology DeVry University, Keller Graduate School of Management April 13, 2014 Subject of Course Project: Information Technology Management: Unification of the actual and future information systems used by Incodepf and the new global innovations in technology. Table of Contents 1. Abstract 2. Brief Company background 3. Discussion of business problem(s) 4. High level solution 5. Benefits of solving the problem 6. Business/technical approach 7. Business process changes 8. Technology or business practices used to augment the solution 9. Conclusions and overall recommendations 10. High-level implementation plan 11. Summary of project References ABSTRACT Incodepf SA is a Colombian company focused on manufacturing, distribution, and commercialization of snacks, which serves national and international customers. The objective of this paper is to explain and include Incodepf into the recent information technology for the internal processes. The information technology is used for finances, sales, inputs and outputs of raw material, receive and deliver emails, internal communications, etc. However, the information system has not been used deeply inside the Human Resources Department. Brief Company background INCODEPF SA is a...
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