... 1 Checkpoint Eligibility, Payment, and Billing Procedures Patricia Walker HCR 220 / Claims Preparation 1: Clean Bills of Health Axia College of University of Phoenix Professor Natalie Cooper June 9, 2011 Checkpoint 2 In patient benefits eligibility there is a number of factors that could determine whether a patient is eligible for certain benefits , such as checking to see if a premium is required , if so then the patient has to pay them on time. Although eligibility for Medicaid is able to change on a monthly basics. Another is if a person has an employer – sponsored health plan, the person’s status of employment becomes a deciding factor as well as the providers’ status as an in network or out –of- network provider as being listed on the plan master list of providers. The appropriate steps that would need to be taken if the patient insurance does not cover the plan and procedure to be done, then the healthcare provider need to inform the patient of the situation about their insurance eligibility of coverage. Therefore Ms. Smith should become aware that her delivery and prenatal care is not covered threw her insurance. So that way she could settle the financial account at that time. The two examples that I provided below relates to the eligibility factor of Ms. Sandra Smith charges with corresponding billing transactions. Example...
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...Eligibility, Payment, and Billing Procedures * Describe a factor that determines patient benefits eligibility. * What are the appropriate steps to take when insurance does not cover a planned service? * Relate these steps to the eligibility factor you identified and provide two examples of patient charges with corresponding billing transactions. Some factors that determine a patients benefits eligibility is their age, marital status, immigration status, healthcare needs, and work history. Also, if the patient works for a company that provides insurance, the insurance company may only cover the health care until a certain dollar amount, and then the patient is responsible for the rest. The appropriate steps to take when the insurance plan does not cover the service that is planned for the patient is to first tell them! The patient needs to be told and explained to that the insurance plan does not cover their service that was planned and if possible, why it is not covered. Many people think that their insurance will cover many different services but, this is not always true. I am still unaware of what my insurance plan covers and does not cover completely. Then, the patient needs to be told that if they choose to continue with the planned service, the insurance company nor the provider will be responsible for the remainder of the bill. They need to be told that they will be responsible for paying the bill completely. Some choose not to go through with the procedure...
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...Results-oriented, detailed professional seeking to apply my education and experience. Proven ability to handle all aspects of student eligibility and recruitment. Extremely skilled in responding to student inquiries and determining backgrounds, goals and objectives. Hands on experience of creating and implementing treasure and project finance reporting, loan agreement and payment collection policies monitoring, monitoring and bank accounts analysis, calculation of net cash, cash balance reporting, scheduling of subordinated loans, associated to financial strength of, companies, maintain cash, debt, and interest schedules, maintain online access to all bank accounts keep track of associated, service agreements, archive all project finance folders in a standard format this also, includes availability of all important documents electronically, work closely with project finance analyst for all existing and new, funding projects, track expenses and sources of funding for efficient funds management, maintain banking relationships act as liaison between bank personnel, and management, prepare and submit the funding proposals to banks, perform as a complete backup to project analyst, keep strict confidentiality of information. In depth knowledge of reviewing and making recommendations about applicants. I have over 9 years of collection experience with a profound knowledge of the FDCPA and HIPPA acts. Highlights Superior time management Superior multi-tasking Complex problem solving Accurate...
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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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...Therapy Billing Tips Provider Reference Supplement [pic] HP Enterprise Services, Arkansas Title XIX Document Date: 5/12/2010 HP Enterprise Services Arkansas Title XIX Account 500 President Clinton Avenue, Suite 400 Little Rock, Arkansas 72201 (501) 374-6608 HP Enterprise Services and the HP Enterprise Services logo are registered trademarks of HP Enterprise Services. All other logos, trademarks or service marks used herein are the property of their respective owners. HP Enterprise Services is an equal opportunity employer and values the diversity of its people. © 2010 HP Enterprise Services. All rights reserved. Contents Introduction 3 Eligibility 4 Restricted Aid Categories 4 All Arkansas Medicaid Aid Categories 6 Therapy Benefits 10 Program Coverage 12 Prior Authorization Request Procedures for Augmentative Communication Device (ACD) 15 Evaluation 15 Contact List for Reviews, Managed Care and Authorizations 16 National Place of Service Codes 18 Quick Tips for Submitting Claims 19 Introduction to Billing 19 CMS-1500 Billing Procedures - Occupational, Physical, Speech Therapy Procedure Codes 19 Augmentative Communication Device (ACD) Évaluation 22 Billing Instructions - Paper Only 22 Completion of the CMS-1500 Claim Form 22 Special Billing Procedures 29 Common Billing Errors 30 Brief Overview of Benefits 31 Contact Information 32 Introduction This Billing Tips document serves as a training supplement...
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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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...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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...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 makes notes of the examination and...
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...Steps in Medical Billing HCR/220 6/8/2012 Theresa Rosado The processes of medical billing used in healthcare, providers and insurance companies have to submit and follow ups in order to receive payments from the medical services. Ten steps are used to complete the medial billing process. There are three categories which is visit, claim, and post claim. Visit makes up the first categories that consist of the first four steps. Pre-registering the patient is the first step in the visiting area. The two main tasks of pre-registering are schedule and update appointments and collect pre-registration demographic and insurance information. When patients call for an appointment they provide their personal and insurance information for the scheduler. Also the scheduler will ask if you are a new or returning patient. The first step is to pre-register the patients and get all of their contact information and insurance information. The second step is try to establish financial responsibilities for all visits and verify insurance eligibility and figure out how much that needs to be collected up front from the patients. A patient that is insured, questions must be answered. For an example: what is the patient responsible for paying? And what are the billing rules of the plan? When the question is answered it would help the medical insurance specialist. In order for the financial responsibility, the procedures need to be followed: check the health plan’s coverage, verify patients’...
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...University of Phoenix Material Steps in the Medical Billing Process Part A Reference: Ch. 1 of Medical Insurance Complete the following table by identifying the 10 steps in the Medical Billing Process. Write 2 to 3 sentences describing each step. Be as specific as possible. For example, Step 1 may be, “Preregister Patients.” |Step |Description | |Step 1: Preregister patients |The patient schedules and appointment to see the doctor. The doctor’s office collects | | |preregistration demographics and insurance information. Appointments are updated if | | |needed. | |Step 2: Establish financial responsibility |Once the appointment is made now you have to see what is covered under the patient’s | | |insurance plan. What is not covered? You also need to find out the billing rules of the | | |patients insurance. | |Step 3: Check in patients |When the patient arrives for their appointment they are to sign in. Once they do that new| | ...
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...| You Decide | Activity | Assignment Responses | Part I | From the Chief Compliance Officer (CCO) perspective on HIPAA, contemplate the three basic areas which HIT professionals must be most concerned with are: (1) Privacy Rules (2) Security Rules, and (3) Standardized transaction code sets | Write a paragraph on each of the 3 critical areas of HIPAA for a training session of your staff. Explain what they are, why they are important and how they impact staff duties and the organization. | HIPAA Rules (1) Privacy Rules: HIPAA Privacy Rules involves federal protection of individually identifiable health information and guarantees patient rights and prevents healthcare fraud and abuse. This is important to prevent identity theft (especially in the fraudulent use of health insurance) by reducing fraudulent use of patients social security numbers/birthdates, protecting a patient diagnosis and treatment and any other personal patient information (address, home/work phone numbers, place of work). This will impact staff and organization by what information can be accessed (ROI or Release of Information) by what staff and what information the organization/hospital may release to third parties whether it is another physician/hospital or insurance company. (2) Security Rules: HIPAA manadated series of rules which safeguards the integrity of administrative, physical, and technical information (EPHI- Electronic Protected Health Information).Will allow covered entities to adopt...
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...athenaCollector: A Medical Practice’s Premier Billing and Workflow Application In 1997, Jonathan Bush and Todd Park purchased a birthing practice in San Diego, California. When they ran into insurance reimbursement issues they began to look for existing electronic medical records (EMR) and practice management solutions to help solve their problems. They were unable to find software that met their needs so they decided to create their own program and as result athenahealth, Inc. was born. Three years later, co-founders Jonathan Bush and Todd Park introduced a billing and practice management service called, athenaCollector. In 2006, athenahealth, Inc. launched athenaClinicals, advertised as the "first economically sustainable, service-based" electronic medical records (EMR) system (“athenahealth Introduces,” 2006). In August 2008, it announced the acquisition of MedicalMessaging.net (“athenahealth to Acquire,” 2008). Today athenahealth has four main services: • athenaCollector - A web-based physician billing and practice management solution that reduces administrative red tape that allows you to efficiently assess, plan, and improve practice performance while increasing revenue (“athenaCollector,” 2012). • athenaClinicals - An electronic health records (EHR) system, delivering increased revenue, decreased cost, and more clinical control to medical practices. With flexible, web-based Certification Commission for Healthcare Information Technology (CCHIT) certified software...
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...processed. Image result for life cycle of a medical billing claim A new patient is defined as a person who has not received any professional service from the health care provider or another provider of the same specialty in the same group practice within the last 36 months. An established patient is a person who has been seen within the last 36 months by the health care provider or another provider of the same specialty in the same group practice. There are three parts to the development of a claim: • The preclinical interview and check-in • The clinical assessment...
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...Eligibility, Payment, and Billing Procedures Janessa Ashford HCR/220 There are a few factors that determine a patient’s benefits eligibility. Some of these include: whether coverage may end on the last day of the month in which the employee’s active full-time service ends. The employee may no longer qualify as a member of the group. For instance if a part time employee does not get benefits at that job, the employee may lose benefits when they lose hours. An eligible dependent’s coverage may end on the last day of the month in which the dependent status also ends, or reaching the age limit stated in the policy. When you work for a company full time and receive benefits, if you drop down to part time, you may lose those benefits. Most places do this. If someone is not eligible for the benefits trying to be used, the patient will then be responsible for the total themselves. Most offices require a signature stating that if your insurance does not cover the procedure or visit, the patient is then responsible for all charges. The place of business must let the patient know, first, that their insurance denied a claim and that they now have a balance due. If someone with full-time benefits has preventative care with no co-pay, then drops down to part-time and less benefits, their policy could change and they could no longer have preventative services covered...
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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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