Five steps
Initial Processing
Automated Review
Manual Review
Determination
The company I chose to analyze is WorldCom. This company based in Mississippi had recognized that for several years it has been bloating or increasing their earnings through booking about $3.8 billion expenses as long-term investments rather than operating costs. They did that by posting operating expenses such as salaries and wages as long-term investments on the balance sheet while those costs should have been expensed and posted to the income statement. When they did that, they overstated assets while extremely understating expenses. This led to an overstatement of net income; the company then devalued such costs which led cash flows, profit margins and net income to be affectedly inflated. Given the fact that those are the key measures used to value the company’s stock, the company’s stock was highly overpriced.…
The total fixed cost is subtracting the variable from low time period: $20,500 - $13,755.00 = $6,745…
Answer the following: The conclusion that can be drawn about the frequency of compounding interest is that the more frequency the better. The conclusion that can be drawn about the length of time an amount is compounding is the same the more or longer the better. It just keeps adding up.…
Explain some of the graphical user interfaces (GUIs) and communications messages that occur during the operation of a microwave…
The purpose of a General Appeals Process is used to challenge payer’s decision to reduce, deny or to downcode any claim. The provider however, can ask for a review of the payer’s decision. The patient also has a right to ask for a request of the appeal. The claimant or appellant is the one that is filing the appeal. That could be an individual who is the provider or the patient. The basic steps are simple of the appeal. This is where the payer has a consistent procedure to handle the appeal. This has to do with what kind of appeal it is. The practice staff does a review on the procedure before other actions are taken. The staff then takes the necessary steps to move…
How does HIPAA serve to protect patient rights? What areas of the JSBMHA did HIPAA compliance impact? What actions should the JSBMHA director take about the HIPAA violation? Explain your answers in detail.…
Because this is an important step, many facilities use a professional to prepare the claims and send them out. A claim contains a patient’s diagnosis, treatment, and charges to the coverage company. These claims need to be extremely accurate and filed on time. Monitoring the payer adjudication is step eight, it helps the coverage companies decide if they should pay the full claim, part of the claim, hold off until further information is obtained, or denied completely. After the decision is made, a letter is sent back to the facility and a specialist makes sure that all the payments are accounted for and the reasons for denial are given. Many times the coverage company does not pay the full amount and here is where step nine comes in. What the company will pay is deducted from the patient’s bill and the final bill is given to or sent out to the patient to pay their…
Enter the correct answer for each item by typing either a or b in the second column. Provide an explanation for each choice in the Rationale column. The boxes expand to accommodate your text.…
Petersen breaks down the book in five parts . He starts off with part one the value of of communication balancing: listing awhile , talk until the other person stops hearing , Listen until the person calms enough to hear again. He furthers this in a another chapter. He then moves on to the Flat-brain theory . He uses diagrams to explain the different levels of Stomach functions which is where the our emotions are located . This area is were we experience our inner nudges . He also explains…
It is the legal responsibility of a worker to maintain the health and safety practices in place and work in a way to ensure that they do not endanger theirs or other’s health, safety and welfare.…
Describe a real-life problem where you have or could have used the scientific method. Include the steps involved in solving the problem.…
There are times that the claims are not complete and are return to the medical office for further information. Because a lot of claims have been sent back to the medical office they have to come back with a decision that is evaluating compliance strategies in medical coding to keep the billing consisting and efficient.…
Why is it important to complete a readiness assessment prior to starting an exercise program?…
I would tell the members of the Senate that mental health is just as important as physical health. Health professionals say that there is a solid link between the mental health and physical health. The health and illnesses are not just related to biological issues, but is a combination of biological issues, social conditions, and behavioral factors. If we want our society to deal with all of the health issues that they may face, we need to bring a health care policy that takes into consideration of all these things.…
If a patient visits a specialist but did not receive the required authorization prior to the visit, the claim may be denied, resulting in the provider’s need to appeal the claim (Jacob, 2001). Healthcare employees who handle billing and claims must be certain that all of the information they have for each patient is correct and up to date, and that they receive all necessary authorizations prior to performing any procedures. Additionally, insurance clerks have to be certain that they are using the proper procedure codes and not unintentionally over coding. Should a claim be denied, no matter the reason, it must follow the three steps of the appeals process. These three steps are complaint, appeal, and grievance. By filing an appeal, the claim can be paid when it was previously denied, reduced, or down coded. After the appeals process and decision, if a provider or patient is still not satisfied, the appeal can be taken to an outside authority, like a state insurance commission…