...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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...In Order to be eligible for In-State Tuition, you MUST complete this form THE ALABAMA COLLEGE SYSTEM CERTIFICATION OF ELIGIBILITY FOR IN-STATE TUITION In order to be eligible for in-state tuition, you MUST complete this form and fall into ONE or more of the following categories: I. Legal Resident of the State of Alabama I (or my non-estranged spouse) have lived in the state of Alabama for at least 12 continuous months immediately preceding my application for admission. I am a dependent student and my parent/legal guardian has lived in the state of Alabama for at least 12 continuous months immediately preceding my application for admission. I graduated from an Alabama High School or obtained a GED in the State of Alabama within three years of the date of my application for admissions. I have more substantial connections with the State of Alabama than any other state. Check all that apply: Location of high school graduation. Payment of Alabama State income tax as a resident. Ownership of residence or other real property in the state and payment of ad valorem taxes on the residence or property. Full-time employment in the state. Residency in-state of spouse, parents, or children. Previous periods of residency in the state for one year or more. Voter registration and voting in the state. Possession of state or local licenses to do business or practice a profession in the state. Ownership of personal property in the state, payment of state taxes on property, and possession of state...
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...Eligibility Rules Holly Regan HSM/240 February 20, 2014 Terra Harris Eligibility Rules Eligibility Rules of Human Service Organizations Offering Shelter for the Homeless | Program Types of $ Counted Concept Underlying Idea Beneficiary Unit of Concern Wages Assets of “Need” | United States Department of Veteran Affairs is the second largest department in the United States the first is the U.S. Department of Defense. | No Requirement | No Requirement | Medical needs, income support, and permanent housing needs. | Veterans and their dependents. “The term “veteran” means a person who served in the active U.S. military, naval, or air service and who were discharged or released under conditions other than dishonorable, [Reference 38 USC 101(2)],” DVA (2014). | Mary’s Shelter is an independent non-profit corporation. Since this corporation is faith-based some government and private funding is unavailable. | Percentage if they are in the workforce to pay for a portion of services and the remainder goes into a savings account for them to have future stable housing. | Only a consideration if they have anything substantial and accessible to them while under the age of 18. If so, the funds will be used only toward future stability. | At or below 200% federal poverty level,Subsidized shelter...
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...Evaluating Eligibility Rules HSM 240 Rules are important in every aspect of life. Eligibility rules are equally important for any kind of services offered, especially those offered to assist the general public. The Arc program, as well the local Chemung Arc, is an organization developed to assist those with developmental disabilities and just like every other organization, it has eligibility rules for the people it assists and services. ARC has eligibility requirements that most would consider not too difficult to establish. Any person with any kind of intellectual or developmental disability is accepted into the ARC program, where services vary depending upon need. The catch to these services is the way a person and/or their family will able to financially make the decision to join the organization. The eligibility rules for such programs as Medicare and Medicaid may be the toughest rules to fall into. Being defined as intellectually or developmentally disabled is done by a doctor, usually at a very young age. Being diagnosed as disabled by a doctor falls under: eligibility by professional discretion. Once diagnosed, unfortunately lots of doors and opportunities close for a person. In order to successfully go to ARC for assistance in opening these doors back up, Medicaid is a popular route to take for financial assistance. Information on applying for Medicaid services is very limited online. ARC states, “Medicaid is, however, extremely complicated” (The ARC, 2013)....
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...Evaluating Eligibility Rules In all agencies everywhere there are qualifications to receive assistance. These qualifications are also known as eligibility rules. With eligibility that means that you have to meet the requirements to be accepted into the program. Whether it is gender, age, social status, height, weight, or area you live in. All organization has the authority to come up with their eligibility rules. A program must have structure because without it the program would not be successful. There has to be a limitation to how many people a program can help at a time because overcrowding takes attention away from people. The Beachway therapy center only accepts 24 clients at a time. This helps the members to have individual attention, and specifying on their needs. Certain insurances apply. Those listed are Assurant Health, Insurance partners, Humana, Aetna, Cigna, BlueCross BlueShield, and United Healthcare (Beachway, 2010). To see if a person’s insurance is accepted there is a number listed on their website or you can fill out and submit an application and the agency will be sure to contact a person within 24 hours. Among admittance there must be a psychological history given, especially for a patient with a “dual diagnosis”. All the other patients must pass a physical exam from a family doctor and have the results sent to the treatment center prior to being accepted into the program. Due to the type of insurance a client has, there are limitations of the number...
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...Evaluating Eligibility Rules Sarah Wegner HSM/240 January 25, 2015 Ricardo Castro Evaluating Eligibility Rules The Salvation Army of the U.S.A. is held in high esteem by the public as an excellent community and human services provider. This program is a compilation of programs under the principle of service through the word of Jesus Christ. They state as their mission: “The Salvation Army, an international movement, is an evangelical part of the universal Christian Church. Its message is based on the Bible. Its ministry is motivated by the love of God. Its mission is to preach the gospel of Jesus Christ and to meet human needs in His name without discrimination” (2009). The Salvation Army application of rules for prior contributions, administrative performance, private contract arrangements, use of professional discretion and confidentiality, attachment to the workforce, and application of proper judgment (2005) allow for best practices to be applied. They also use means testing which applies an analysis of need less assets plus income. All of these factors speak well for them in making an evaluation of this organization. Regardless of any other eligibility requirements, The Salvation Army offers its services to anyone who is in need. Anyone who is affected by a disaster can qualify for services through their programs. This is a simple process because of the fact that The Salvation Army acts as a second responder which makes it easier for them to accept many families...
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...Eligibility Change in the NBA The National Basketball Association is a billion dollar business and is known as one of the largest and most prestigious organizations within American sports today. It is also home of one of the most controversial rules in all of sports, which is known as the “one and done rule.” The one and done rule restricts high school basketball players from entering the NBA Draft straight out of high school (Zegers). According to this policy, anyone who wants to enter the NBA Draft must complete at least one season and school year at the collegiate level or be at least the age of nineteen. This policy created by NBA Commissioner David Stern went into effect for the 2005-2006 season of the NBA (Medcalf). The creation of this rule between the National Basketball Association and the players union caused immediate backlash from many players who all felt that the policy was very unreasonable. The one and done rule should be changed to either go play in college for two years or be able to head straight to the NBA, because coaches have difficulty recruiting players who only want to play one year and it could be bad for players to have to go to school first if they were to suffer any problems that could occur due to their decision. Millions of Americans including myself are huge fans of college and NBA basketball. I love to watch my favorite college basketball players go to the NBA and follow their career of playing professional basketball. Prior to the creation...
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...Eligibility, Payment, and Billing Procedures Darlitta Rose Shepard HCR/220 Claims Preparation: Clean bills of Health 10/11/2015 Lydia Cavieux Eligibility, Payment, and Billing Procedures * Describe a factor that determines patient benefits eligibility. Verify the patient’s eligibility for benefits. As a medical insurance specialist you are to abstract information about the payer/plan from the patient’s information form (PIF) and the insurance card. Then contact payer to verify three points: 1. Patients general eligibility for benefits 2. The amount of the co-payment or coinsurance required at the time of service. 3. Whether the planned encounter is for a covered service that is medically necessary under the payer rules. These items are checked before an encounter, except in a medical emergency when care is provided immediately and insurance is check after the encounter. * What are the appropriate steps to take when insurance does not cover a planned service? As a medical insurance specialist attempt to determine whether the planned encounter is a covered service. If the service will not be covered, that patient can be informed and made aware of financial responsibility in advance. * Relate these steps to the eligibility factor you identified and provide two examples of patient charges with corresponding billing transactions. According to our reading Ch.3 Medical insurance. As a slightly older woman I can relate to the both. I have called my...
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...order to qualify, the families must be income eligible, without any recent drug or violent criminal activity. Eligible families are afforded to rent safe, decent and sanitary housing in the private rental market. The family pays 30 percent of their adjusted income towards rent; and HUD subsidizes the remaining portion directly to the landlord via DHA. However, the Colorado Coalition for the Homeless is a private organization that advocates for and provides a continuum of housing and a variety of services to improve the health, well-being and stability of those it serves, whether it is a family, disabled veteran, mentally ill individual, or a single man or woman. Depending on the circumstances that you are in, the qualifications and eligibility requirements will be different. They have programs that offer housing facilities with lowered rents for low to moderate income families, or transitional housing for an individual whom has been approved for section 8 and is waiting for a...
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...PAPER-III MANAGEMENT Signature and Name of Invigilator 1. (Signature) __________________________ (Name) ____________________________ 2. (Signature) __________________________ (Name) ____________________________ Roll No. (In figures as per admission card) OMR Sheet No. : ............................................... (To be filled by the Candidate) J 17 1 1 2 Roll No.________________________________ (In words) [Maximum Marks : 150 Number of Questions in this Booklet : 75 Time : 2 /2 hours] Number of Pages in this Booklet : 16 Instructions for the Candidates 1. Write your roll number in the space provided on the top of this page. 2. This paper consists of seventy five multiple-choice type of questions. 3. At the commencement of examination, the question booklet will be given to you. In the first 5 minutes, you are requested to open the booklet and compulsorily examine it as below : (i) To have access to the Question Booklet, tear off the paper seal on the edge of this cover page. Do not accept a booklet without sticker-seal and do not accept an open booklet. (ii) Tally the number of pages and number of questions in the booklet with the information printed on the cover page. Faulty booklets due to pages/questions missing or duplicate or not in serial order or any other discrepancy should be got replaced immediately by a correct booklet from the invigilator within the period of 5 minutes. Afterwards, neither the Question Booklet will be replaced nor any extra...
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...Checkpoint 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...
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...Once a client has completed the LARS general intake form the client completes the Self-Sufficiency eligibility paperwork with the SS Program Coordinator or with another case manager. If the eligibility paperwork is completed with the SS Program Coordinator then at this time the SS Program Coordinator will hold an information session with the client about the program entails and the requirements of participation. If the eligibility paperwork is filled out with another case manager the SS Program Coordinator will call the client and have the client come in for an information session after the SS Program Coordinator has reviewed the eligibility paperwork. Following the information session and the review of the eligibility paperwork the SS Program Coordinator...
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...Age Restrictions on Alcohol Relative to Military Eligibility I expect you to protect our country. I am going to give you a gun and when ordered to I expect you to take another human life without question. I expect you to be willing to die and watch others around you die. However you will not be allowed to drink alcohol and if you do you may face military and criminal charges. This is what we tell our soliders that are under the age of twenty-one. While most of us agree that the legal drinking age should be twenty-one plus there should be exceptions for our military personal who we expect to protect our country and die if needed. The minimum age to join the military in the United States in seventeen years old with parental consent or eighteen years old without parental consent. If we consider this in greater detail we can surmise that at age eighteen you are old enough to make the choice to join the military and put your life at risk. You are also given a great responsibility of protecting our country. For those that do not enlist in the military their responsibilities are typically much less. While there are certain to be exceptions, most young adults between the age of eighteen and twenty-one are concerned with school, work, friends and dating. Their level of maturity and understanding on life is not fully developed and they are just starting to explore the world on their own. Prior to 1984 some states did allow people to buy and consume alcohol at the age of eighteen...
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...Use Only Resubmitted Relocated Received Sent Completed Eligibility under 8 CFR 274a.12 (a) or (c) Authorization/Extension Valid From Authorization/Extension Valid To Economic necessity under 8 CFR 274a.12(c)(14), (18) and 8 CFR 214.2(f) Subject to the following conditions: I am applying for: 1. A# Applicant is filing under section 274a.12 (First Name) KIRAN YADAV 2. 3. U.S. Mailing Address (Street Number and Name) 1660 LOBLOLLY COURT (Town or City) KENT (Middle Name) (Apt. Number) 322 (State) (ZIP Code) OH 44240 4. Country of Citizenship or Nationality INDIAN 5. Place of Birth (Town or City) NASURULLABAD (State/Province) TELANGANA 6. Date of Birth (mm/dd/yyyy) 7. Gender 8. Marital Status Married $ Male (Country) INDIA 01/15/1992 Divorced ( c ) ( 3 ) ( B ) 17. (c)(3)(C) Eligibility Category. If you entered the eligibility category (c)(3)(C) in Question 16 above, list your degree, your employer's name as listed in E-Verify, and your employer's E-Verify Company Identification Number or a valid E-Verify Client Company Identification Number in the space below. Degree Employer's Name as listed in E-Verify Employer's E-Verify Company Identification Number or a Valid E-Verify Client Company Identification Number 18. (c)(26) Eligibility Category. If you entered the eligibility category (c)(26) in Question 16 above, please provide the receipt ...
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...SAP Eligibility Rules Jeanine Jones University of Phoenix HSM/240 December 10, 2013 In an organization, eligibility rules are so important because they allow clients to receive benefits and services. Eligibility rules seek the resources that are available to the clients and ration them so that people can learn and benefit from resources. Sometimes when the eligibility rules are not correctly propositioned, people will not even the available resources. Decisions need to be made and whether a person qualifies for assistance falls between guidelines that are set into place for the greater good of the clients. The Substance Abuse Program is an important organization whose eligibility rules matter the most because the inmates have already been stripped of all of their rights. The main eligibility process for the Substance Abuse Program is through Judicial Decision. Because the Substance Abuse program is only offered to incarcerated inmates and this opportunity is handed down by a judicial ruling. Inmates may plead their case to the court, and in many instances they know that being accepted into the program means reduced sentencing. Instead of focusing on getting out of custody to return to the same habits, inmates should really appreciate the special program that they are limited to. Judicial decisions are important because each ruling is different. The Substance Abuse Program has been around through the correction facility for a while and there are certain...
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