...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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...------------------------------------------------- Billing Memo This is a notice to all staff of the required documentation needed in order to receive proper reimbursement from insurance payers. As described previously, if the patient’s information is not documented in their medical record we cannot receive reimbursement for those services. We cannot bill for services that has not been documented, this is unethical and considered fraud. In order to avoid these issues we as staff must provide these minimum documentation in a patient’s chart. These documents are as follows: Chief Complaint of the patient for the date of service; the patient’s medical history; any physical exams performed on the patient at the time of service; new discoveries or findings will need to be documented; additional diagnostic testing ordered by the physician to include medical necessity of such testing; an assessment of the patient needs to be documented as well; a conclusion or doctor diagnosis must be documented if one is present at the time of visit; a treatment plan must be documented along with any doctor recommendation s for a follow-up visit. In addition to minimum documentation requirements, there are some electronic solutions to help the staff ensure accurate evaluation and management coding. Those electronic solutions are included in our database, EZ Claims, as a claim scrubber. This claim scrubber will notify staff if we are billing inaccurate E&M codes based off documentation requirements...
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...Briefly explain causes and solutions for three of the most common billing and coding errors. What effects does the medical national correct coding initiative have on the billing and coding process? Pg.207- 211 Working in medical billing and coding can be very challenging and demanding. In this field there is absolutely no room for any mistakes. There are many common billing errors such as using inappropriate modifiers or no modifiers, billing an invalid or outdated code and billing non covered services. Most health care payers base their decision to pay or deny claims only on the diagnosis and procedure codes. Simple errors and mistakes such as typos, incorrect dates, and double billing. Typos, or typing mistakes, can occur when entering a patient’s name or address. Although these may seem not as vital compared to entering the correct code it’s still very important to double check all records, files, and bills before submitting them. There are ways errors in billing and coding can be solved. Patients need to review billing statements when they receive them by mail, to be certain that the statements contain no typos, incorrect dates, or double billing. Improper coding that can lead to incorrect payment for Medicare claims. These claims are controlled by the Medicare National Correct Coding Initiative (CCI). The coding policies of the CCI are derived from the coding guidelines of national medical societies. Physicians are required by CCI to report the most extensive version of...
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...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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...John Huter Credo, K. MGMT 525 – ORGB Acadian Ambulance: Billing Practices Acadian Ambulance Service was originally founded in 1971 as Test Acadian by Roland Dugas, Richard Zuschlag, and Richard Sturlese. It was a privately owned ambulance service company created to fill a void after funeral homes stopped providing the service because of troublesome federal regulations. The Lafayette Parish Policy Jury (the governing body of the parish at that time) approved of the three men’s idea on July 21, 1971 and granted them exclusive rights to provide ambulance service for the parish. Over the years, Test Acadian evolved into Acadian Ambulance Service, and has since expanded into two other states and has grown exponentially. The firm’s parent company is Acadian Companies, Inc. Under Acadian Companies, the firm has six other companies that provide medical transportation for citizens and education and training for potential employees, amongst others. Today, Acadian’s headquarters is still based in Lafayette, Louisiana and continues to provide ambulatory service in both emergency and non-emergency situations. The company is a regional powerhouse covering 3 states and maintaining approximately 4000 employees and a fleet of ambulances, helicopters, and other transportation vehicles. The firm was recently designated as the largest privately owned ambulance service provider in the U.S. Of the three original founders, Zuschlag remains active CEO of the company. When a company becomes...
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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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...that I have done, there appears to be ten steps in medical billing. The steps are as follows: * Preregister patients * Establish financial responsibilities for visits * Check in patients * Check out Patients * Review coding compliance * Check billing compliance * Prepare and transmit claims * Monitor payer adjudication * Generate patient statements * Follow up patient payments and handle collections For step one, preregistering patients gives you all the information that you will need as in contact information and insurance information. This way when billing comes up you know who you need to contact whether it be insurance or patient. Step two is knowing WHO is going to pay for any medical procedures that need to be preformed. Verifying insurance eligibility and figuring out how much to collect up front from the patient is a must. Step three is having the patient sign in, collect whatever necessary money from them, copy or scan their current insurance information. Step four is checking out the patient, and verify one last time that you have all of the correct information from the. Step five is to obtain CPT and ICD-9 codes from the doctor(s) and verify that all information is correct before entering it into the computer system. Codes can be tricky and you need to make sure that you have all of you bases covered when entering them in. Step six is making you know how to submit billing for different insurance claims. I know that every insurance...
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...Characterization of Lester Billings As a parent you work hard, but the hard work won’t always reward you. In the story “The Boogeyman”, Lester Billings is the main character. He’s 28 y/o and he lives with his wife in Waterbury, Connecticut. Lester Billings and his wife brought three children to the world, but now they aren’t here anymore, the children were all killed. When Billings was at a psychiatrist, dr. Harper, he was telling him about his horrible experiences in their home in the children’s room. We get to know a lot of things about Billings and what happens in his life; therefore we know he is a round character. While Billings was talking to dr. Harper about what happened to his last dead son, Andy, he was smiling. “And I didn’t want to move him. I was afraid to, after Denny and Shirl””But you did move him, didn’t you?” Dr. Harper asked. “Yeah,” Billings said. He smiled a sick yellow smile, “I did.” Billings moved his last-born son into the room where the two other children were killed by the boogeyman that lived in the closet in the room. It seems like Billings is haggard and is having trouble by handling the fact that an unknown monster from the closet killed all his kids. That’s why he smiles when he talks about it, he feels guilty because he did move him into the other room. He knew that it probably would happen to him also, but he didn’t do anything about it. When we look at Lester Billings past, we know that Lester felt like his mother was too overprotective...
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...| Billing Process LaJessica Demas July 26, 2015 Christine Singel The medical billing process makes sure that all parties in the health care facility such as doctors, patient care techs, nurses and insurance company are paid and credited properly. The process makes sure that they all get paid, either by the insurance company or by the patient. Everyone involved must fulfill important responsibilities in order for everyone to get paid. Patients that are receiving any type of healthcare services are billed for the services they receive inside of a hospital or clinic. If the patient has any type of medical insurance, then the way they are billed will depend on the type of insurance coverage that they carry. The first step of the billing process involves determining the patient's insurance coverage and billing insurance for the patient's healthcare services. This is done during admissions or a visit, a medical assistant will collect a patient’s information such as, the patient identification card, insurance name, policy number and deductible amount. Next, the insurance provider will be contacted through phone or a computer based system, to confirm that the patient is covered, then collect any co-pay if needed. Billing third party plans, is the insurance claims or employee benefit plans for separate entity. Billing a third party plan can be a patient’s employer, which may choose to help finance a patient’s health care cost. These components...
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...Medical Billing Process Nathia Herod HCR/220 2/26/2012 Melinda Sousa Medical Billing Process There comes the time in everyone’s life that just about almost everyone who is adults has gone through some part of the medical billing process. It is a process in what keeps most workers in the field their job and some patients their health. In the end, in order for everyone to be satisfied, everyone must play their role and work together. In order for the patient to understand what they are paying for; the biller must know who to bill and what they are paying for as well. There are ten steps of the medical billing process and the first step of this process would be to always pre-register the patients. When you break this step down a little further all it means is that you are setting appointments for the patient but first thing’s first, you must get their insurance in order to know what the patient is going to pay and what they are not going to pay. When the patient is done being preregistered; you are now available to state their financial responsibility for the visit. Most of the time when patients are preregistered, they kind of already have a prejudgment as to what they are going to pay because of their insurance which also establishes a financial responsibility. You must clarify clearly in the beginning as to why they are paying for this and not paying for something else. You must always try your best to get the patient to understand or else there will be a lot...
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...International School of Informatics and management, Jaipur Billing System Synopsis TEAM GROUP - 04 TEAM MEMBERS -ANIL KUMAR ANJANA -BHAIYA LAL ANJANA -SAURABH JAIN PROJECT GUIDE - Ms JYOTI KHURANA (Lecturer of MCA) Table Content 1) Introduction 2) Objective 3) Project category 4) Types of Reports 5) Technologies and tools 6) Hardware 7) Future scope 8) Analysis of Present System 9) Problem of Existing System 10)Characteristic of Proposed System 11)Feasibility Analysis i. Need for Feasibility Study ii. Technical Feasibility iii. Behavioral Feasibility iv. Economic Feasibility v. Product Perspective 12)Data flow diagram 13)Entity Relation Diagram 14)Data tables 15)Flow chart 16)Input forms 17)Conclusion 1. Introduction The project “Billing system” is an application to automate the process of ordering and billing of a “Departmental store” .This web based application is designed considering the chain of departmental store which is located in various cities. This application also administrates its users and customers. 2.Objective This project will serve the following objectives:1 2 3 4 5 6 7 Add and maintain records of available products. Add and maintain customer details. Add and maintain description of new products. Add and maintain new entered category of products. Provides economic/financial reports to the owner monthly or weekly and yearly. Provides a convenient solution of billing pattern. Make an easy to use environment for users and customers. ...
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...Running Head: MEDICAL BILLING AND CODING Medical Billing and Coding as a Career Abstract: Since I became a mother, I have always wanted a job that would allow me to work at home. I have an associate in accounting and tried doing bookkeeping from home but that did not really work out. I did some research and found that being an insurance medical biller and coder is one of the best jobs to have for working at home. Top Medical Billers can earn over $40,000 a year either at home or in the office. “Employment of billing and posting clerks and machine operators is expected to grow by about 4 percent from 2006 to 2016. In 2006, billing and posting clerks and machine operators held about 542,000 jobs; 566,000 jobs are projected by 2016.” (medicalcareersguide, 2007) In choosing a new career path I did a lot of research on my options. The path to success always starts with the right attitude, education, training, networking, and experience. We want to inspire you by not only speaking about the medical billing and coding career but also by giving examples of real people who succeeded. Learn all there is to know about entering into this rewarding field, finding medical billing jobs, and succeeding in your chosen career. This website also answers many questions about starting your own medical billing business, either in a small office space, or from home. I decided upon medical billing and coding because it is a rapidly growing healthcare field and it sounds exciting....
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...Medical Billing and Coding The program that I am currently in, is medical billing and coding. Some professionals that are medical coders with a minimum of an associates degree, are a part of an organization that is called AAPC. AAPC stands for American Academy of Professional Coders. In 1988, AAPC was founded to provide education and professional certification to physician-based medical coders (AAPC, 2014). In order to be a part of this organization, a member has to follow by a specific protocol. Another organization that is most known and recognized, is The American Medical Billing Association (AMBA).There's a list of different certifications that one could gain, as a medical billing and coder. Just to name a few more, CMRS (certified medical reimbursement specialist) specializes in insurance reimbursement. CHBME (certified healthcare billing and management executive) is geared toward managers, executives, and supervisors (A-T-M-B, 2014). Professional standards in the healthcare field, means having a certification or a license. Having a certification, means you indeed, have met the specific requirements. Depending on the specific job one chooses when entering into the healthcare field, in order to practice in the state that one lives in, it is mandatory that one has a license to practice within that state. The importance of professional standards in healthcare, is for one, to distinguish yourself from others who are not certified or licensed. It shows how dedicated you are...
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...El Reto del Récord Médico Electrónico en Puerto Rico Por Manuel A. Quilichini Estados Unidos ha acogido con ferocidad la consigna del Presidente Bush de que en diez años debemos tener en operación en la nación americana un sistema de expedientes de salud electrónicos (“Electronic Health Records” o “EHR”). Esta no es una consigna sencilla, dada la complejidad de esta encomienda. Para empezar, necesitamos un sistema uniforme de identificación de pacientes, seguido por nomenclaturas uniformes y sistemas que se puedan entender entre sí. Y si consideramos la población actual de 295,734,134 habitantes, la magnitud de la tarea es increíble. La creación de identificadores de pacientes sin utilizar el número de Seguro Social es solo uno de los grandes problemas de este sistema propuesto Pero por otro lado, hay aspectos que facilitarán la implantación de este sistema. Por ejemplo, existe una excelente infraestructura de comunicación que está creciendo a pasos acelerados y que permitirá la transmisión de todo tipo de data a velocidades extraordinarias. La existencia de organizaciones tipo “manager care” que atienden una población amplia facilita la automatización y el brinco al récord médico electrónico. Hasta el gobierno está poniendo de su parte, con la implantación de un tipo de récord médico electrónico dentro del Departamento de la Defensa, y muchas universidades continúan con sus iniciativas de automatización de sus centros médicos y facilidades...
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...The Electronic Health Record (EHR) is a electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter as well as supporting other care-related activities directly or indirectly including evidence-based decision support, quality management, and outcomes reporting. A government-sponsored survey of the use of computerized patient records by doctors points to two seemingly contradictory conclusions, and a health care system at odds with itself. Skip to next paragraph A government-sponsored survey of the use of computerized patient records by doctors points to two seemingly contradictory conclusions, and a health care system at odds with itself. The report, published online on Wednesday in The New England Journal of Medicine, found that doctors who use electronic health records say overwhelmingly that such records have helped improve the quality and timeliness of care. Yet fewer than one in five of the nation’s doctors has started using such records. Bringing patient records into the computer age, experts say, is crucial to improving care, reducing errors and containing costs in the American health care...
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