...which became a law under President Bill Clinton (Physicians Billing Associates International, 2006). The Health Insurance Portability and Accountability Act includes provisions for: health insurance portability, tax- related provisions, fraud and abuse control, revenue and offset provisions, group health plan requirements, and administrative simplification requirements (Physicians Billing Associates International, 2006). The HIPPA act was put into place as a standard law used to protect a patient’s personal health and medical records nationwide. This act was created to help health care workers to keep better control of a patient’s personal information. HIPPA has a privacy rule that concerns an individual’s health plans; the rule helps to provide health care workers information that would be needed to transmit an individual’s vision, health, prescription, and any other type of medical information safely. This essay will discuss how Rite Aid pharmacy informs customers of how his or her personal information is disclosed and how he or she is protected against violations of their rights, ensuring customers that his or her information will continue to remain to stay protected and that the HIPPA privacy laws are continued to be followed. As well as the law suit that arose where Rite Aid agreed to pay $1 million dollars to settle a HIPAA privacy case (Physicians Billing Associates International, 2006). The Rite Aid pharmacy recently put out an updated article concerning patient privacy...
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...for health plans to meet the specific and constantly changing requirements established by the Centers for Medicare and Medicaid Services. It also served to facilitate the performance of clinical medication management services at the retail pharmacy level. They are partnered with over 50,000 pharmacies. Major corporations such as Aetna, Care1st, CVS Caremark, and Wellcare are just a few of their many health plan clients, and their services affect approximately 8.5 million patients. Their web interface, known as Mirixa ProPlatform, analyzes prescription claims data from the health plan to target patients who are most likely to benefit from their services. It alerts the pharmacist when eligible patients are identified with potentially billable services. The comprehensive medication review (CMR) required by...
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...prescription refill with a maximum savings of up to $50 per prescription. INSURED PATIENT BILLING Submit a primary claim to your patient’s insurance, and then submit a secondary coordination of benefits (COB) claim to AlphaScrip. BIN: 610600 PCN: AS Group and ID numbers: located on the card PRIOR AUTHORIZATION If your insured patient’s insurance provider denied the primary claim due to a Prior Authorization (PA) requirement, please initiate the PA process to help your patient save on future NUVIGIL prescriptions If you have questions regarding prior authorization or need forms to assist your patient initiate the prior authorization process, please go to CoverMyMeds.com for assistance PATIENTS WITHOUT INSURANCE COVERAGE FOR NUVIGIL Submit a primary claim to AlphaScrip using Other Coverage Code: 00 or 01 BIN: 610600 PCN: AS Group and ID numbers: located on the card For assistance or questions regarding pharmacy billing, please contact the AlphaScrip Pharmacy Help Desk at 1-877-274-3244. The correct Other Coverage Code is required (see below). Editing the Other Coverage Code may be necessary. 03: if primary insurance has denied coverage or 08: to reduce the patient’s primary co-pay expense First Prescription FREE* If your doctor prescribes NUVIGIL for you, present this page, including the NUVIGIL Prescription Savings Card, and your first prescription for NUVIGIL to any participating retail pharmacy and receive your first prescription FREE (up to 30 tablets). Refills as low as...
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...healthcare industry, and it seems there is a silver lining to this cloud. Studies say that security, regulatory and privacy concerns might get in the way of cloud computing in the healthcare industry, although this sector is set to grow in the medium term. Cloud computing in healthcare is projected to grow to US$ 5.4 billion by 2017. Modernization in the healthcare system is going beyond Electronic Healthcare Records (EHR). According to research firm MarketsandMarkets, the use of cloud computing in healthcare will span both clinical and non-clinical applications. Apart from EHR, cloud computing will also apply to other clinical uses, such as physician order entry and software imaging and pharmacy use. Non-clinical uses will likewise benefit, including management apps for patient billing, claims and revenue cycle management. According to MarketsandMarkets, the use of cloud computing in healthcare will be greatly beneficial in sharing EHR data across facilities in different geographic locations. Using cloud applications will ensure that patients get treated on time, regardless of location and facility. According to a 2011 study by KLAS Research, 55 percent of hospital executives interviewed said they stored data on the cloud. This included applications like clinical software and email. 71 percent of healthcare providers already deploy, or are planning to deploy, cloud-technology services. However, there is doubt among healthcare providers what cloud computing actually entails...
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...Definition of Terms Health care as its own language and abbreviations and so does the systems used to manage health care beyond the patient. Many systems are required to perform tasks like billing, scheduling, and receive payments from payers. Each system has a purpose and function that fulfills the needs of the organization to operate. The systems are used for administrative, statistical, and financial reasons. Organizations need to have the right system to perform the needed tasks correctly and efficiently. Ambulatory Medical Record Ambulatory medical records (AMR) are medical records from an urgent care or physician offices. If the urgent care or physician’s office is using the same systems as a hospital they can be linked to show visits in the ambulatory setting. The ambulatory medical record also can be from home care facilities that make visits to the patient’s home. The medical records are stored within the office providing the care. The ambulatory medical records system can be designed to include billing, coding, and transcription of physician notes. The benefits of the AMR are physicians can also increase compliance to standard and guidelines of diseases, increase time spent with the patient, and reduce space needed in offices for paper charts. Computerized Medical Record A computerized medical record (CMR) is the health information and data about an individual stored within a computer. The use of computerized medical records recently has been a requirement...
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...Home Based-Medical Billing - Marketing Plan Outline 2.0 Situation Analysis Medical billing / Coding is one of the fastest growing health care jobs, The US Bureau of Labor Statistics predicts that medical coding and billing will remain among the top fastest growing occupations for many years to come. Fact is: over 500,000 practicing physicians and hospitals in the USA rely heavily on medical coders and billers for customer service, and more importantly: to get reimbursed for medical services provided to patients. (http://www.medicalcodingandbilling.com) Many Billing services currently operate to manage medical practice billing among other services offered, providing physicians with the benefit and convenience of outsourcing their billing duties to third parties in order to relieve medical professionals of the tedious and challenging work that entails medical billing and account collections. National statistics show that only about 70 percent of insurance claims, initially submitted on paper, are ever paid by insurance carriers. With the advancements of health information Systems and the increase requirement and demand for electronic submissions Claims have increased the reimbursement percentage tremendously. A survey by the American Hospital Association concluded that about 18% of medical billing and coding positions remain unfilled due to a lack of qualified candidates. Occupational trends and future outlook for Medical Billing and Coding Specialists remain at the...
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...Proficient in Microsoft Word, Excel, PowerPoint, Publisher, Outlook, Strong Internet Research. Trained in CPT-5, ICD-9, and HCPCS coding Strong leadership skills – able to problem solve issues that arise in the workplace in a professional manner Experience in all aspects of insurance: Medicare, Medicaid, and third-party payers knowledgeable in Medical Billing and Coding Guidelines Manage multiple tasks at once, with strict adherence to time constraint Excellent communication skills – Trained and experienced in group facilitation and conflict resolution. Can articulate opinions written and orally. Understanding of Spanish. Highly detailed and customer service oriented and functions well independently or as a team member Experience Tufts Health Plan Medicare Preferred (Watertown, Ma) November 2012 – Current Member Services-Call Center • Responsible for verifying, documenting and coordinating information needed to process applications and other Eligibility Operations assignments • Conducts health insurance policy analysis, documentation verification, employer coordination and customer service while ensuring accurate data entry, validation and timely processing. • Verify, document and investigate the presence of health care coverage for Medicare recipients 65 or older\ disabled • Complete periodic reports. • Customer service to include high volume of phone work answering questions and other inquiries regarding...
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...Rite Aid Corporation which ranks as the third largest retail drugstore chain in the United states, control about 2,380 drugstores in 28 states across professionals pharmacy service, a full selection of health and personal care products, an assortment of general products in the nation and in the District of Columbia ( Rite Aid, 2007 ). Rite Aid has a great management team to help them with their success their team includes Chairman, President and Chief Executive Officer, Special Advisor, Corporate Strategy ,Chief Operating Officer ,Chief Administrative Officer ,Executive Vice President – Pharmacy, Executive Vice President, Store Operations ,Executive Vice President and General Counsel( Rite Aid, 2007). Differentiate between management and leadership is very different for example, response to its huge losses, Rite Aid has said it expects to spend more than $94 million to reassess and restate its financial results for 1998 and 1999( ). Furthermore, that includes rerunning mainframe-based accounting systems and paying IT people overtime to work with internal and external accountants and auditors during the process. Still, Rite Aid does not plan to replace its combination homegrown Computer Corp. accounting system.Rite Aide challenged by the complication and lack of standard interfaces the finance and accounting functions support throughout the organization. Data is not formats or transported in standard border or structure. Manual work is required to fit data within budget codes and...
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...care and efficiency. With the growing reliance on digital records for everything from patient test results to medical records to billing and HIPPA reporting, high level of availability Epic HER environment has never been more important. Epic creates and provides integrated software to health care organizations so they can take better care of patients by improving outcomes, enhancing the patient’s experience, and supporting research. All of Epic’s applications are built on a single database, providing an integrated solution that supports patient care and continuity throughout hospitals, clinics, and physician offices. Using these applications, health care organizations and professionals can access the appropriate patient information instantly whenever and wherever needed. Epic is privately held health care software company. In 1979 it was founded by Judith Faulkner. The company headquarters was in Madison, Wisconsin, but in 2005 the company moved to Vernon, Wisconsin (Epic, 2013). The software’s market is largely healthcare organizations, and it is an interesting suite of healthcare software centered on a MUMPS database. Epic System provides the healthcare management software that integrates financial and clinical information across the organization in one database. The systems software includes scheduling, billing, registration,...
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...Rusty James D. Miranda 12-11-13 BSBA III- HRDM Mrs. Sotto HR Organizational Chart BabeBiiBoBu Medical Doctors is open for different post: 1. Accounting Clerk Job Purpose: Supports accounting operations by filing documents; reconciling statements; running software programs. Accounting Clerk Job Duties: * Maintains accounting records by making copies; filing documents. * Reconciles bank statements by comparing statements with general ledger. * Maintains accounting databases by entering data into the computer; processing backups. * Verifies financial reports by running performance analysis software program. * Determines value of depreciable assets by running depreciation software program. * Protects organization's value by keeping information confidential. * Updates job knowledge by participating in educational opportunities. * Accomplishes accounting and organization mission by completing related results as needed. Skills/Qualifications: Organization, Financial Software, Reporting Skills, Attention to Detail, PC Proficiency, Typing, Productivity, Dependability 2. Admissions Director – Hospital Job Purpose: Admits patients by directing the admissions process; developing, implementing and maintaining revenue-generating strategies; determining and implementing admissions best-practices; promoting the hospital; maintaining a satisfied patient base. Admissions Director - Hospital Job Duties: * Accomplishes...
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...Annual reports are given as comprehensive as possible, reporting a company's prior years activity. Shareholders and other interested parties are given information concerning the company’s financial performance. These reports must be filed with the company’s registry and may be required to be publicized, it depends on the area. More regular reports are required of those companies listed on the stock exchange. Most reports contain: Chairperson's report, CEO's report, Auditor's report on corporate governance, Mission statement, corporate governance statement of compliance, Statement of directors' responsibilities, Invitation to the company's AGM and financial statement information. [pic] Lincare Holdings Inc. was founded in 1972 and is headquartered in Clearwater, Florida. Providers of oxygen and other respiratory therapy services to home health care market in the Lincare Holdings Inc. also supplies home medical equipment ( hospital beds, wheelchairs and other supplies) that present helpful to consumers. State-of-the-art oxygen system producers from 1965. Known for making 24-hour, seven-days-a-week reliability, professional service representatives, and staff, Lincare provides: Oxygen Therapy, Respiratory Services, Infusion Therapy, CPAP, Ventilators, NVS, Enteral Therapy, Pediatric Respiratory Services, Patient Education & Rehabilitation. Individualized services to the prescribed need of each patient. Sanitarily providing respiratory equipment with monitors to...
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...Laura Goldston NLU HCL 425 "EMR as HUB” What an exciting time to become part of the health care industry! Medical research makes new discoveries to improve the quality of patient care and save lives on a daily basis. Health care reform is gaining momentum, revolutionizing the industry and requiring many administrative changes, such as the creation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Rules and standards evolved from this act provide a way to ensure your protected health information remains confidential. In this digital age, it is particularly relevant. The digital evolution impacts many areas. Digital TVs, computers, smart phones and iPods have totally changed the way we do business and enjoy entertainment. In the medical industry, the digital evolution provided advanced imaging technology, and a variety of other significant improvements for treating patients. On the administrative side, the development of practice management programs and electronic health records streamline office workflow and helps provide patients a more efficient and cost effective experience. EMR is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. CPOE Computerized Physician Order Entry or CPOE is the process of capturing a physician's instructions for a patient's care electronically to improve the efficiency of care delivery. Use CPOE...
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...Definition of Terms Shaun W. VanDevender HCS/533– Health Information Systems Professor Derrick Dugeon September 1, 2014 Definition of Terms Technology has greatly changed health care in many different ways. This change has been gradual, progressing over several years; it has been very profound, nevertheless. Understanding these changes is important for experienced health professionals and newcomers alike. The following paragraphs will provide some definitions for the following important abbreviations: AMR, CMR, CMS, CMS-1500, CPT, DRG, EPR, HL7, ICD-9, and UB-92. In addition, the importance of each term will be discussed. AMR According to Techtarget.com an ambulatory medical record (AMR) is an electronically stored file of a patient’s outpatient medical records, which includes all surgeries and care that do not involve being admitted to a hospital. An AMR is similar to an electronic medical record (EMR) but while EMRs keep track of inpatient care (surgeries and care that require spending overnight or longer in a hospital), AMRs only apply to medical procedures and care that do not result in an overnight stay in a hospital or that are given in non-hospital settings such as urgent care clinics, physicians’ offices and at-home medical care. AMRs assure that patients receive appropriate care. AMRs provide clinicians information they need to get a complete picture of the patients health. In addition, consumers can use the health information in the AMR to better communicate...
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...0 3 0 Electronic Health Records in the Physician Office CHAPTER OUTLINE Patient Flow in the Physician Practice Step 1. Pre-Visit: Appointment Scheduling and Information Collection Step 2. Patient Check-in and Payment Collection Step 3. Rooming and Measuring Vital Signs Patient Examination and Documentation Step 4. Patient Checkout Step 5. Post-Visit: Coding and Billing Post-Visit: Reviewing Test Results Coding and Reimbursement in Electronic Health Records Computer-Assisted Coding Clinical Tools in the Electronic Health Record Decision-Support Tools Tracking and Monitoring Patient Care Screening for Illness or Disease Identifying at-Risk Patients Managing Patients with Chronic Diseases Improving the Quality and Safety of Patient Care with Evidence-Based Guidelines E-Prescribing and Electronic Health Records Keeping Current with Electronic Drug Databases Increasing Prescription Safety Saving Time and Money LEARNING OUTCOMES After completing this chapter, you will be able to define key terms and: 1. 2. 3. 4. 5. 6. 7. 8. 9. List the five steps of the office visit workflow in a physician office. Discuss the advantages of pre-visit scheduling and information collection for patients and office staff. Describe the process of electronic check-in. Explain how electronic health records make documenting patient exams more efficient. Explain what occurs during patient checkout. Explain what two events take place during the post-visit step of the visit workflow. Describe the advantages of computer-assisted...
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...0 3 0 Electronic Health Records in the Physician Office CHAPTER OUTLINE Patient Flow in the Physician Practice Step 1. Pre-Visit: Appointment Scheduling and Information Collection Step 2. Patient Check-in and Payment Collection Step 3. Rooming and Measuring Vital Signs Patient Examination and Documentation Step 4. Patient Checkout Step 5. Post-Visit: Coding and Billing Post-Visit: Reviewing Test Results Coding and Reimbursement in Electronic Health Records Computer-Assisted Coding Clinical Tools in the Electronic Health Record Decision-Support Tools Tracking and Monitoring Patient Care Screening for Illness or Disease Identifying at-Risk Patients Managing Patients with Chronic Diseases Improving the Quality and Safety of Patient Care with Evidence-Based Guidelines E-Prescribing and Electronic Health Records Keeping Current with Electronic Drug Databases Increasing Prescription Safety Saving Time and Money LEARNING OUTCOMES After completing this chapter, you will be able to define key terms and: 1. 2. 3. 4. 5. 6. 7. 8. 9. List the five steps of the office visit workflow in a physician office. Discuss the advantages of pre-visit scheduling and information collection for patients and office staff. Describe the process of electronic check-in. Explain how electronic health records make documenting patient exams more efficient. Explain what occurs during patient checkout. Explain what two events take place during the post-visit step of the...
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