References: http://www.cleveland.com/healthfit/index.ssf/2012/06/medical_billing_errors_what_ca.html
References: http://www.cleveland.com/healthfit/index.ssf/2012/06/medical_billing_errors_what_ca.html
The ten steps to the medical billing process can be categorized into three main groups. These three groups are the visit, claims, and post-claims processes. When it comes to the visit category, this category has a great deal to do with the patients personal information getting the patient established, such as pre-registering the patient. This is the process when we use the HIPPA privacy act to help gain the trust and confidence of the new patients and returning patients to our office. Also, we have the step that we take to inform the patient of his or her obligations to pay this is another form of the HIPPA act that we must follow when it comes to the patient’s personal information such as finances. The claim category uses the help of the ICD, CPT, and the HCPCS billing strategies to help ensure that we are doing all that we can to fully utilize the patients insurance and to better suit the patient. When using these forms we are reviewing the coding compliances. We are also checking billing compliances, when we are made responsible for billing the correct information and codes to the insurances that are involved. In the claim category we are also made aware that we must follow any rules that the proper billing and coding standards set for us. Preparing and submitting the claim is the key to success in any office this is why this process is so important to follow. The last category of the steps that we come to is post- claims where monitoring payer adjustments, generate patient statements, and follow up with patients payments along with any collections. This step brings us back to following any HIPPA regulations when it comes to collecting payment and gathering information for collections. This privacy act must be acknowledged at all times and followed to ensure that you get paid and the patients can not complain. Looking back over these steps it is important to follow each and every one of them so that every party involved gets the outcome that he or she…
The person submitting forms to the insurance company may have put information incorrectly onto the document. This can create a problem with insurance companies and in turn can cause more problems. It is important for a medical professional to be careful and diligent as it will not only save time for the physician but also for his office. Not to mention, the patient will be…
In this case study, the hospital operated on the incorrect patient. This is classified as wrong-site, wrong-procedure, and wrong-patient errors (WSPEs). These wrong-site, wrong procedure, wrong-patient errors (WSPEs) are termed “never events” by the National Quality Forum and “sentinel events” by the Joint Commission are errors that should never occur and indicate serious underlying safety problems (Woods,…
Working in the medical billing industry can be daunting at times. My last position as a follow up representative, proved to be the most challenging job that I have ever had. I have an extensive background in the medical insurance industry. I was aware of the way that claims were to be handled and submitted to insurance companies. The company that I had worked for had just won a contract for taking over the medical billing for twelve physicians in Portland, Oregon. Right off the bat, there were a variety of issues concerning how to bill the medical claims correctly. Claims have to be submitted on time, with the correct codes and information on them, before they can be processed by the insurance company.…
A new companywide compliance system platform is needed for Wicket Inc. due to company expansion. In addition, new compliance system policies will be introduced. It is required for all managers to be trained appropriately to complete their jobs and perform properly. Training will be organized and managed as part of the Bluebird project.…
of two error MS-DRGs may be assigned when invalid documentation is given on a patient’s…
This is step four, reviewing coding compliance, which makes sure that all guidelines are followed while the codes are assigned. A diagnosis and procedure code are used in the patient’s account and entered in the patient ledger that updates their account information. Step five takes us to review the billing compliance; there are many types of fees for the services provided by a facility. Medical insurance specialists help by determining what a patient needs billed to them and what the insurance company should pay for. Checking out the patient comes next in the steps of bill processing. The payments for the patient visit are taken care of in this step while the patient is still in the office. The codes are completed, the balance has been figured, and now the charges are discussed with the patient. After everything is paid or billed, follow-up work is scheduled, and the patient is finished in the…
There are ten basic steps in the medical billing process. Each step has certain things which must be done to correctly complete the entire process. In order to complete your duties as a medical biller efficiently, you must follow the medical billing process. Following this process leads to maximum and appropriate payments in a timely fashion. These steps range from the pre registration of the patient to the collection of the payment. In this paper each step will be describe with a brief outline of what each step entails.…
In step four; checking out the patient, along with applying and entering proper codes (Valerius et al., 2008); you are complying with federal regulations for coding and billing. In step five; the process of reviewing coding compliance (Valerius et al., 2008), you are, again, satisfying official requirements. When checking billing compliance in step six; you are assuring the proper charges have been billed and correcting any errors (Valerius et al., 2008). This reduces the risk of liability to the practice for improper billing or fraud, thereby maintaining a proper compliance plan within the practice (Valerius et al., 2008).…
When a claim has been processed and paid, the amount paid will have to be applied to the amount charged for individual patient’s treatment in the Medical Billing Software. This makes it possible for the billing office to track the payments received from different angles. The billing office would want to track the payments received based on differed criteria.…
The receptionist or other clerical worker will either call, or receive a call from a “patient” or other authorized individual. During this communication, the associate must be careful to observe HIPAA rules related to “protected health information.” when “schedule, canceling, or rescheduling” encounters. When gathering benefit “information,” the representative must be diligent to accurately enter data into the “patient’s” file. Discerning insurance cards, policies, and all applicable guidelines of each plan are applicable to the “front and back” office. Abiding by the payer’s regulations, and the coordination of benefits,” associates will input this data into the patient management program (PMP). During these procedures, insurance specialists will be cautious to correlate the correct information with the correct patient. The “front or back office” will then confirm coverage with designated plans, along with all essentials, such as if a “referral or preauthorization” is a requisite. Prior to consulting with the physician, patients will need to be alerted about their rights, in coordination with HIPAA privacy standards, as well as those of the provider. During that time, if the patient owes any monies for coinsurance, or copayments, this will be submitted to the “front office.” While checking out patients, insurance specialists will transfer the descriptions of “diagnoses and procedures” from the “physician’s report” into appropriate “codes” for ‘claim” generation. This facet is most crucial, because of the HIPAA specifications regarding the transfer of PHI “by covered entities” (Valerius et al., p.…
There are so many methods of evaluation compliance strategies in medical coding then meeting with the doctor and billing staff to make sure the necessary handbooks are understand and how to use the coding systems. The insurance companies sends out there rules and guidelines to make sure the billing staff has a better understanding in billing codes and form completion procedures. One of the biggest complaints that the insurance companies have is that the doctor reports are incomplete. This is very hard on the insurance companies to give the properly bill for what the patient was diagnosis…
Accurate documentation in clinical practice is a significant component of the delivery of quality patient care. Evaluation and management (E&M) codes comprise to assist providers adequately . In order to receive reimbursement from health insurance companies, APNs must accurately use E&M codes to bill for services they provide during patient encounters. Hence, the significance for APNs to be knowledgeable in the use of E&M codes to bill for patient care services provided and stay abreast on current and future guidelines. For new APNs, understanding the history, purpose, and components of E&M coding is fundamental in avoiding legal and ethical dilemmas that may arise throughout their practice. The following discussion will address the issues…
To understand how fraud impacts coding systems one must understand how medical professionals and health care facilities are reimbursed for their services. In most cases a patient does not pay for a service directly. Most payments to medical professionals and health care facilities are made by a third party payer, whether it is private insurance or a government program like Medicare. “The ICD-9-CM is used by physician’s offices to code and classify morbidity data from medical records, physician offices, and surveys conducted by the National Center for Health Statistics” (Valerius, Bayes, Newby, Seggern, 2012, p. 128). This is the coding process. They billing or coding specialist fills out the coding form to send to the third-party payer (insurance company) so the hospital or physician’s office can be reimbursed for the services rendered.…
A medical billing and coding specialist’s main goal is to provide medical billing and coding services so the health provider is paid for medical services rendered. Every medical service is assigned a numeric code to define diagnostics, treatments and procedures. It is the medical biller and coder’s job to enter this information into a database using medical billing and coding protocol to produce a statement or claim. If the claim is denied by the third-party payer, the medical billing and coding specialist must investigate the claim, verify its information, and update new details into the database. Medical billing and coding specialists are also responsible for dealing with collections and insurance fraud.…