...Paul Carter HCA-240 Health Care Accounting and Billing April 6, 2013 Professor York Billing Process What is the process that is utilized when producing a final bill? In which ways are pricing and charging different in health care from other industries? What are the ways that private and government insurers and payers impact the actual reimbursement process in health care? The process for producing a final bill in health care starts with the medical record and coding which are communicated to the payer to start the payment process. In 1996 the Health Insurance Portability and Accounting Act (HIPAA) designated two specific coding systems to be used when reporting to both public and private payers. The two coding are International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) and Healthcare Common Procedure Coding System (HCPCS). The ICD-9-CM provides information for diagnoses and procedures while the HCPCS just provides information in the procedure area. The next process would be the charge entry and charge master which have to do with the capture of charges for the services performed, incorrect billing and billing late charges. With charge capture can be done in two different ways paper documents or charge slips. Which is done by the data processing or the business office that identifies the services that was performed on a patient? When producing a final bill they will also sometime use the charge explosion system that will use one code...
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...The medical billing process is a process in which by medical billing specialist to provide maximum, payments for medical services that are provided. The medical billing process contains ten steps and these steps are made up of three categories: The visit, the claim, and post claim. During the visit steps one through four occurs. Pre-registering the patient is the first step. This where an appointment is scheduled and updates are made to pre-register the patient. Collection of all information such as, insurance and demographics on the patient is collected during this visit. Reason for the visit is provided at this time. Determining the patient’s financial responsibility is the second step. If the patient has insurance coverage verification of patients eligibility must be made .The patient is responsible to pay whatever percent of the bill that the insurance does not cover and if no insurance is provided the patient is responsible for the cost of all services that have been provided. The third step of the process is checking the patient in. New patients are required to provide medical insurance if available and medical information is collected for the patients’ file. If patient is a returning patient then information is verified and if any information is incorrect or has changed then it is then updated. Photocopies of Drivers licenses and insurance cards are taken and filed in the patients’ record. If there are any Co-payments that need to be made are...
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...Medical billing is a process that doctors and insurance companies use. Doctors use the process to submit claims to insurance companies so they can be paid for their serves rendered. The billing process consists of 10 steps. These steps have been broken down into three different categories. The visit, the claim, and the post claim. The first category consists of the first four steps. The first step in this category is “The Visit”. During this step the patient is pre-registered. A returning patient or a new patient is pre-registered by making appointments for a future visit or an appointment to start serves. Each patient upon their visit is as asked for their insurance information and demographic information. Returning patients and new patients are to provide the facility with the medical purpose of the visit. Step two is to determine what the patient’s financial responsibility will be. The patients insurance usually has a set payment, which is usually 80/20. The insurance will pay 80% of the bill and the patient is responsible for 20% of the bill. For patients that are uninsured, the patient is responsible for all of the medical charges. Step three, the patient actually gets check-in. Returning patients are asked if all information is still the same as the last visit. Which includes insurance, address, phone number, ect. New patients are asked for all medical and insurance information. All patients are asked for proof of insurance cards and identification, which are photocopied...
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...Medical Billing Process HCA 220 11-03-13 Axia University of Phoenix Medical Billing Process When you go to the health care provider’s office for care, the admitting or office registration department gathers information about you the person responsible for paying for the services and the insurance that will be billed. Step 1: Pre register Patients. By scheduling and updating appointments get the patients demographic and insurance information. Step 2: Establish Financial Responsibility for their visits – verify insurance eligibility and figure out how much to collect from the patient. You get this info by figuring what services are covered by the plan and what services are not covered, and if there are any billing rules to the plan. Step 3: Check in Patients have them sign in then collect whatever necessary money from them, and copy or scan their current insurance card. When this is a new patient they collect detailed and complete demographic and medical information. A regular patient would need to verify their demographic and medical information is correct. Step 4: Review Coding Compliance. Compliance means actions that satisfy official requirements, with coding compliance means following official guidelines when codes are assigned. Obtain CPT and ICD-9 from the doctor(s) next verifies all information is correct before entering it into the computer system. Step 5: Review Billing Compliance. This is where you need to figure out which fee is associated...
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...Assignment: Understanding the Patient Intake Process Name Axia College of University of Phoenix HCR 220 Date Tekne, a Greek word which means an art or craft is where the word technology is derived from. Technology is the study or science of crafting, which are logia. The way in which healthcare is delivered is changing due to clinical information technologies. In an effort to support advancement and innovation of technologies in healthcare, research organizations are creating networks of delivery systems and health plans. The focus of this clinical information technology is centered on a prevention-based, consumer driven model of healthcare. The innovation of new technologies is dependent on many factors: Clinical accountability, consumer demand, research programs, medical advancements, population health targets and the capacity and resources as an industry for technology development. Innovation stimulates the industry to produce large quantities of medical devices and therefore promote them to the healthcare providers. The “clinical pull” of technology, is sometimes impervious with the “technology push" because physicians often resist the change of new technology due to its significance or its impact on day-to-day workflow (Protti, D). With the accessibility of computers, physicians are now able to look up information on his or her patients. Some physicians do not have the capability to write electronic prescriptions or digital health records...
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...Steps in the Medical Billing Process Stacy Dickson HCR/220 March 20, 2011 Alexander Mejia Steps in the Medical Billing Process The medical billing process is one that requires attention to detail to ensure that all the proper paperwork is completed properly and accurately. This process will begin form the time the patient enters to register for their appointment until after they have finished their appointment. This paper will provide the step by step process. Visit Step 1 Preregister Patients As part of the medical billing process, preregistering patients is required. This could be scheduling a patient for an appointment or it could be to update a patients appointments. This also allows insurance information to be updated in the patient’s files and to retrieve any demographic information. The medical scheduler will also inquire for the reason of the visit so that the appropriate amount of time is allotted for the visit. Step 2 Evaluate Financial Responsibility Evaluating the financial responsibility of the visit is extremely important, to ensure that the patients insurance covers and what the patients is responsible for. It is also establish if any prior authorizations are required before services are performed. Step 3 Check In Patients When a patient new patient arrives it is necessary to take a copy of their insurance card, drivers’ license, and have them complete a new patient form with their medical history, home address...
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...Steps in the Medical Billing Process Annette Callen 02/11/2012 I am writing this paper to discuss the ten steps of medical billing. The ten step process consist of patient preregister, establish financial responsibility for visits, check in patients, check out patients, review coding compliance, check billing compliance, prepare and transmit claims, monitor payer adjudication, generate patient statements and follow up patient payments and handle collections. These steps are under three categories these categories are visit, claim and post-claim; throughout this paper I will explain each of these ten steps. The first category is visit; step one of visit is preregister patients. This step usually involves the clerks at the front desk or nurses depending on the size and location of the health center. The clerks are responsible for checking in patients, scheduling appointments and making appointment reminder calls. The clerks are also responsible for collecting the patient personal and payer information. Step two is establishing financial responsibility for the health visit. This step is where the clerks will collect the payer insurance information, set up a payment plan, and let the nurses and doctors know what is covered by the insurance company such as treatments, testing and medications. If the patient does not have medical insurance then the clerks need to determine if the patient needs to be on a payment plan or if they can pay for the service in one...
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...Steps in the medical billing process The following ten steps will show you the order in which to do the medical billing process: I. Pre-Register patients: patient’s appointments are needed to be scheduled and kept updated. Basic insurance information should be added to the patient’s record, as well as their personal information: age, gender, weight, and height. To make sure no appointments get missed a reminder call should be made. When the patient makes their appointment, ask for an insurance card, copy it front and back then add to the patient’s medical record. II. Establish financial responsibilities for visits: As the patient shows they have insurance: their health plan coverage needs to be reviewed and its eligibility needs to be verified. It is recommended to be sure to ask the patient whether or not if there is more than one insurance company. If this is true, then the first payer should be decided. Once verified and checked that all provisions have been met, steps need to be followed to acknowledge payment for services. III. Check in patients: A new patient who is new to the practice; complete personal and medical information is collected. If the patient is returning their information needs to be reviewed, updated and verified if needed. Insurance cards and identification cards should be copied front and back, and placed in their medical chart. Any office visits that are co-payment dues should be collected at time of service. IV. Check out patients: ...
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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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...Merav Nissim HCR/220 February 4, 2012 Natalie Cooper How HIPAA Violations Affect the Medical Billing Process Part Two The global HIV/AIDS pandemic is the worst infectious disease crisis to confront the world since the bubonic plaque halved the population of Europe in the five years after its arrival in 1347. To date, 22 million people have died of AIDS worldwide; another 36 million live with HIV/AIDS today (Fhi360.org). HIV/AIDS is a difficult topic to talk about and even more difficult is the confidentiality that is involved. Many people are hesitant to discuss it with anyone bedides their loved ones. One has to ensure that it stays confidential, and anyone who is not supposed to know should be made aware that it is not to be shared with anyone else. According to the HIPAA Privacy Rule, it is supposed to protect peoples’ private health information. According to CDC.gov, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) attempts to address some of the barriers to healthcare coverage and related job mobility indepediments facing people with HIV as well as other vulnerable populations. There are certain guidelines that aim to ensure that the confidentiality of people living with HIV/AIDS is not compromised when collecting and storing information about the disease. It provides principles, definitions and technical recommendations to maintain confidentiality, privacy and security when working with HIV-related information. Ensuring this...
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...How HIPPA Violations Affect the Medical Billing Process Ronnie Ward HCR/220 02/12/2012 Regina Kraus How HIPPA Violations Affect the Medical Billing Process Through making sure that a patient demographics are accurate and kept confidential HIPPA is able to affect the medical billing process, this authorization which allows a practice to use the confidential information and to bill that patient information to carriers for services should be placed in the patient file. When pertaining to people infected with this deadly and sometimes fatal disease or virus, AIDS and HIV can be a very touching and secretive issue. This is mostly because those who are affected with the disease are fearful of a breach in confidentiality. The patient fear can directly affect his or her health because the patient will not be seeking medical treatment for his or her illness. HIPPA is an organization charged with the responsibility of making sure patient confidentiality is upheld and that the services he or she is receiving is protected. Because of the patient fear of breach in confidentiality, HIPPA has set rules and regulations in place with criminal and civil penalties for those who violate the patient rights and to ensure that his or her right to confidentiality is protected. Patients who are affected with HIV and AIDS information is not separately addressed by HIPPA, never-the-less general guidelines pertaining to the release of personal health information including the HIV status of a...
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...How HIPAA Violations Affect the Medical Billing Process HCR/220 October 7, 2012 How HIPAA Violations Affect the Medical Billing Process In this paper we will discuss how HIPAA violations affect the medical billing process and why HIV and AIDS information is more sensitive than other types of health conditions. We will also examine the social, legal, and ethical ramifications of improper information disclosure. In 1996 on August 21, the Health Insurance Portability and Accountability Act (HIPAA) was enacted by the Federal Government and signed into law by President Bill Clinton (HIPAA – The Health Insurance Portability and Accountability Act, 2011). According to “Health Insurance Portability and Accountability Act” (2012), “HIPAA does the following; provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs, reduces health care fraud and abuse, mandates industry-wide standards for health care information on electric billing and other processes, and requires the protection and confidential handling of protected health information” (What is HIPAA?). The main reason HIPAA was enacted was to protect patient’s personal health information regardless of its severity. Their personal health information is just that, theirs! For that reason, among many other, it is very important to know that a patient’s personal health information is not to be shared with any unauthorized...
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...HIV and AIDS information is more sensitive than other types of health conditions because HIV is often transmitted through sexual activity or IV drug use, sharing of a needle. A diagnosis like HIV or AIDS implies some socially taboo behavior for some individuals. Also, AIDS was initially thought to be a disease unique to gay males and that stigma has stuck throughout the years. We now know that women and children of all ages, sexual orientations and races can also be the victims of HIV and AIDS. HIPAA demands privacy regarding a patient's personal information. That includes diagnose as well as information regarding sexuality and history of drug use. This applies to all diagnoses, but because of the social stigmas mentioned earlier, people are even more sensitive when it comes to HIV/AIDS disclosures. Inappropriately disclosing information can create family and social stress, employment issues and even housing issues. Discussing, diagnosing, and treating HIV/AIDS is a sensitive, private issue between a patient and his or her provider. This privacy is especially important, because any breach of privacy may result in stigmatization or discrimination against HIV/AIDS patients. Patients who are concerned that their health information will not be held private or secure may be discouraged from being tested for HIV and may be dissuaded from pursuing or adhering to recommended treatment regimens. The need for privacy and security must be carefully balanced with the appropriate sharing...
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...How HIPPAA Violations Affect the Medical Billing Process, Part Two Amber Padgett HCR/220 October 19, 2014 Felecia Pettit-Wallace The purpose of this paper is to relate to ways that the Health Insurance Portability and Accountability Act (HIPAA) violations may affect the medical billing process. While researching, the findings conclude that confidentiality of health information was adopted centuries ago. The findings of the research show that although, HIPAA laws have been put into place to protect the privacy and confidential heath information of patients; HIPAA laws are sometimes violated. The medical billing coders are sometimes careless when handling confidential information; however medical health records should be protected adequately. The coder that violates the HIPAA laws concerning the confidentiality and privacy of patient health information can suffer serious ramifications. The ramifications of these violations could result in serious penalties such as disciplinary actions by the employer, monetary fines, and jail time, or both. HIPAA violations ranks number one among the complaints received by the Office of Civil Rights each year. Humans take pleasure in the right to privacy in every aspect of life. The right of protecting the confidentiality and privacy of identifiable personal health information takes first priority and is greatly cherished among most. The Hippocratic Oath, dating back centuries required physicians to keep medical information concerning...
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...Who is the creater of CP/M? [Kildall] Who is the head of the Multics project. [Carbato] Which OS’s process scheduler reduces priority and increases quantum. [CTSS] Which one is the difference between a semaphore and monitor. [Last choice] If a system has 16 drives and each process can have 4 drives. What is the maximum number of n that the system is deadlock free. [5] Given the sequence below which processes will cause a page fault. (for FIFO – LRU) Write a loop that would create 10 child processes. (No more than 10). If a file is shared by two processes, can have read-only and the other read-write access. If yes how, if not what prevent it. What are some of the security features in UNIX or NT. How does NTFS directory system work. How does UNIX directory system work. Pick a Unix UNIX process scheduler and explain how (not why or when) it favors I/O bound processes to CPU bound processes. Explain and compare I/O software (programmed, interrupt, DMA). What is the problem with RAID4 and explain how RAID5 solves the problem. Disk arm scheduling algorithms readuce read time but what does Linux additionally do. How does Workingset Clock algorithm work. If seektime is 8msec and each track is 160KB. What is the access time to read 4KB. Couffman listed four requirements for a deadlock. Describe fourth one and how to prevent it. What are the advantages of inverted page tables. What is a soft link. Implement soft link and hard links...
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