...Summary The U.S. Government has emphasized EMR (electronic medical records) and ECS (electronic claims system) as an answer to reducing the costs attached to patient care. In addition, electronic systems help in expediting reimbursement of insurance claims. Yet, it is still difficult to perform this task. Currently more than 60 percent of all medical claims in the U.S. are mailed. Submission of paper claims dates back in the U.S. to the early 1950’s. One of the primary reasons for not implementing a new system is the cost of new EMR and ECS systems. In 1990, the federal government mandated that physicians start submitting their claims electronically. This standard only applies to large practitioners and “small” providers can request a waiver from submitting claims electronically. This waiver was established when the government recognized the financial burden new electronic systems could have on small providers. Small providers, however, are losing money due to the inability to access current technology. Mount Brighton is an affordable medical management company that can perform the electronic claims processing for both small and big providers. Mount Brighton is efficient and effective at maximizing reimbursement, working through denials, and working through the appeals process. Industry Analysis Our company will operate in the business-to-business sector providing medical and business solutions to medical and dental offices. In addition, our company...
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...2013 CODER INTERVIEW Like a regular business entity, healthcare facilities need continuous inflow of funds to continue existing. However, billing complexity in the health care industry is unlike all other industries. The biggest difference of healthcare from other businesses is the source of payment for services rendered: the majority of which is from a third party with pre-determined rates and strict prerequisites. Foundational to these prerequisites is the accuracy of medical coding. An interview with a coder provided fresh understanding of the coding profession. And a look into the private and government payers and insurers’ roles brings better understanding of their impact on reimbursement. MEDICAL CODING Medical Coding is the process of using standard codes in identifying medical services and procedure. This is used for billing and reimbursement from payers for services rendered. Medical code is foundational and standardized with industry-wide language. The use of the Healthcare Common Procedure Coding System (HCPCS) is mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), (Medial Billing and Coding). THE INTERVIEW I interviewed an outpatient coder of Pennsylvania Hospital. Her job includes coding for hospital out-patients and Physicians’ in-patients and out-patients. She explained medical coding is quite complex and a coder needs proper schooling and training. She is a graduate of Health Information Management, a bachelor degree...
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...Evaluation Compliance Strategies Medical Billing and coding compliance is very important to the billing world. Billing management starts at the first patient contact and ends only when the account has been paid in full. . In between, there are a series of important steps, each of which is critical for accurate billing and proper reimbursement. In this essay we are going to discuss the importance of the linkage code, implications of incorrect medical coding, and how physicians and payers fee are related to the billing compliance. We are also going to discuss what steps we can take to meet the compliance standards. When claims are filed correctly they will show the connection between the service being billed and the diagnosis code. The linkage code helps determine which procedure goes with which diagnosis code. If the linkage codes are not correct this will cause the claim to be denied. Linkage codes help the payer to determine the medical necessity for the service provided. Payers will determine the coverage by medical necessity. Services that are considered to be of nonmedical necessity are not covered under an insurance policy. It is important that the billing specialist be aware that different payers will have their own set of medical necessity edits. The implications of incorrect medical coding can cause issues for both the medical provider and the patient. Coding incorrectly can cause denial of claims. Providers would lose their patients trust, causing them to...
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...looking into the types of careers I wanted to be in the medical field seemed like the perfect choice for me. Choosing a career in the medical field would give me the opportunity to help others. Now being of age and knowing what a real superhero is and those who make a difference in this world I feel I’ve made the right choice. The three careers in this field that I chose to explore further are medical administrative assistant, clinical medical assistant, and medical coding and billing. I’ve done some research and I would like to take this time to request for reimbursement for my continued education, since our company has this program. Medical Administrative Assistant A medical administrative assistant is a skilled profession that is best suited to those with field-related knowledge developed through formal training. They “must be excellent communicators and use impeccable spelling and grammar when completing professional documents or communicating in writing” (Medical Assistant Careers [MAC], 2016, Duties, Training, Outlook section, para. 1). In addition, medical administrative assistants must be highly proficient in the use of computers and common applications like word processing and spreadsheets. Medical assistants must be adept at multitasking. This job often requires use to remember large amounts of information and handle multiple tasks at once, all while working in a bustling environment. The most successful medical assistants are able to stay calm and clearheaded, even...
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...Medical billing is a process that doctors and insurance companies use. Doctors use the process to submit claims to insurance companies so they can be paid for their serves rendered. The billing process consists of 10 steps. These steps have been broken down into three different categories. The visit, the claim, and the post claim. The first category consists of the first four steps. The first step in this category is “The Visit”. During this step the patient is pre-registered. A returning patient or a new patient is pre-registered by making appointments for a future visit or an appointment to start serves. Each patient upon their visit is as asked for their insurance information and demographic information. Returning patients and new patients are to provide the facility with the medical purpose of the visit. Step two is to determine what the patient’s financial responsibility will be. The patients insurance usually has a set payment, which is usually 80/20. The insurance will pay 80% of the bill and the patient is responsible for 20% of the bill. For patients that are uninsured, the patient is responsible for all of the medical charges. Step three, the patient actually gets check-in. Returning patients are asked if all information is still the same as the last visit. Which includes insurance, address, phone number, ect. New patients are asked for all medical and insurance information. All patients are asked for proof of insurance cards and identification, which are photocopied...
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...History and Future Of Medical Coding and Billing John F. McMahon BU480, Central Methodist University Abstract Medical coding and billing affects everyone during their lifetime and yet the regulations of medical coding and billing are extremely complex. Examining the history, evaluation, and effect of new regulations and their cost shed light on an already complex industry. We will review government regulations, technological advancements, and requirements that providers will face in the near future. We will examine our current systems and how they evolved through time and what they may be in the future. We have reviewed articles from the Medical Billing and Coding Association, the Department of Human and Health Services as well as the Office of the Inspector General. We will review the different types of insurance, how they each affect the process of medical coding and billing and then see what the future will be. Finally we will review what steps we have taken that has allowed a government to be so involved in our healthcare decisions. Thesis Statement Medical Coding and Billing has evolved to a point that it affects everyone at one time or another during their lifetime and has only led to complex rules and regulations that you almost need a degree to understand. From times that Physicians bartered for their services to the government telling them what to charge and insurance companies...
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...MARKETING PLAN FOR ABIGAIL’S MEDICAL BILLING AND CODING Abigail’s Medical Billing and Coding Services, LLC is an accurate, timely and affordabl Here are the major elements of a marketing plan: Executive Summary: The Executive Summary should be a brief summary of the entire marketing plan and include the highlights of each section to be included in your marketing plan. It should also include your Business's Mission (or Vision) Statement. Start with your Mission Statement and use this as a foundation for the rest of marketing plan. Next, work on the rest of the plan, skipping the remainder of this section until the rest of the marketing plan is complete. Your Mission Statement should be a simple paragraph describing your company's values as well as what your company does and who it is. After the rest of the marketing plan is complete, come back and finish the Executive Summary. Product Description: The product description is the detailed description of the products and/or services that you intend to market. Anywhere in length from a few paragraphs to a few pages, use this as an opportunity to communicate your ideas regarding exactly what your product is and how your customers will use it. Market Analysis: The Market Analysis is drawn from in-house or third party Marketing Research and includes: * A description of the target market * Distribution channels with any applicable laws or regulations * The unique positioning of the company and its products...
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...customer service is a big part of caring for someone, we must provide excellent Customer Service to everyone in our Center. From the moment a patient enters our center every individual part forms part of a big Idea that they will take with them. From the warm smile of the Front Desk Staff to the cleanness of the Center all is been judge. Lets all work as a team to find that balance of providing great care while exciding all patient’s expectation. Healthcare offices are all different, it depends if they are a PCP (Primary Care Physician) or a Specialist. They both have different processes but very similar both at the same time. Once thing that they all have in common is that at the moment of opening, they all will allow the patient in and start the check in process. Those patients with appointments will be seen first and some offices will not ever see a patient without an appointment....
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...Generating Solutions and Alternative Solutions Karen Hardwick BSAD 320-E1WW Professor Maria Clemens August 31, 2012 Abstract Finding a solution to my renal billing issue, has involved many steps and techniques. Throughout this paper I will analyze, evaluate, and discuss processes such as, divergent and convergent thinking, black hat, and devil’s advocate techniques. These processes have helped me to seek the solutions I need to come to a final solution to the renal billing problem. Generating Solutions and Alternative Solutions Introduction The main issue of my problem involves renal claims being filed incorrectly. Since there are a variety of claims that Solutions Healthcare files, it is imperative that the claims be filed correctly the first time. I have used a fishbone diagram to address this problem and it helped me address possible reasons as to why the renal claims are continuing to be filed incorrectly. I have noticed that the staff from Portland and Solutions Healthcare needs additional training on the processes used to bill these types of specialized claims. I am now aware that the inconsistencies with management, the lack of resources that are available, and the lack of organization within both facilities are reasons that have enhanced this problem. I have looked deeply at the results of the fishbone diagram and the five problem restatement techniques....
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...(accomplished by taking a copy of a valid photo ID) c. Correct address and telephone numbers allow for sending statements and making contact in order to collect on the account 3. How often should a patient information form be updated? a. At each visit or at 3-month intervals if the patient is being treated for an ongoing problem 4. The job of discussing fees is usually relegated to the a. Medical assistant 5. Name four factors involved in establishing fees for a physician a. What...
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...Deborah Bennett 01/22/2013 HCA 240 Instructor Moiz Lalani Electronic Medical Records from a Business Perspective In this paper we shall analyze how Electronic Medical Records (EMR) impacts health care organizations from a business perspective, as well as how it may impact profit organizations (versus non-profit organizations) differently. In addition we shall discuss perspectives and responsibilities of the financial management staff, and the basic rules and regulations involved with EMR in which the health care financial management of the organization must address. Starting around 1991 the Institute of Medicine (IOM), known to be the leading innovators concerning medical advances, started encouraging those in the health care delivery system to see the future and accept it, by beginning preparation for instituting electronic medical records. Expounding on the many advantages EMRs would allow facilities and physicians alike; such as, providing for more efficiency, through instant access of a patient’s health history (including all labs, tests and meds prescribed by all doctors for the patient) that is stored on the computer and can be accessed throughout the country, and eventually the world. In turn this would also provide for more effective and less redundant care, and with certain software installed for guiding diagnosis and medicine interactions, could also promote error free treatment and care, avoiding life-threatening episodes in this regard (Haupt, 2011)...
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...Paul Carter HCA-240 Health Care Accounting and Billing April 6, 2013 Professor York Billing Process What is the process that is utilized when producing a final bill? In which ways are pricing and charging different in health care from other industries? What are the ways that private and government insurers and payers impact the actual reimbursement process in health care? The process for producing a final bill in health care starts with the medical record and coding which are communicated to the payer to start the payment process. In 1996 the Health Insurance Portability and Accounting Act (HIPAA) designated two specific coding systems to be used when reporting to both public and private payers. The two coding are International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) and Healthcare Common Procedure Coding System (HCPCS). The ICD-9-CM provides information for diagnoses and procedures while the HCPCS just provides information in the procedure area. The next process would be the charge entry and charge master which have to do with the capture of charges for the services performed, incorrect billing and billing late charges. With charge capture can be done in two different ways paper documents or charge slips. Which is done by the data processing or the business office that identifies the services that was performed on a patient? When producing a final bill they will also sometime use the charge explosion system that will use one code...
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...to become a Certified Medical Administrative Assistant (CMAA). I have a diploma in Medical Administrative Asst. but, I won’t to have a little challenge in my life and more money. So I am working on my associate degree, the reason I chose the medical field is because I love helping people I really do not like seeing people down and out so I try to cheer them up, even my kids when they are sick I am weak hearted so to speak. So for me to become a (CMAA) I would need my associates’ degree the diploma is okay and it is a start but having to be certified would make a big difference in my career level. EDUCATION The requirements to becoming a CMAA are to first being trained in the general healthcare office procedure which includes: * Medical billing, coding and reimbursement * Medical terminology * Anatomy and physiology etc. Also, you need to know how to interact with patients where it is in a hospital or a doctor’s office. The responsibilities for being a CMAA starts at the front desk when you see the patients and the duties for this is as follows: * Greeting patients * Ordering supplies for the office * Coordinating patients care * Checking and recording vital signs * Maintain patients records * Filling out insurance forms * Handing correspondent * Scheduling patient appointments * Handling billing and book keeping This for me would be the challenge that I need I like to push myself to see how far I accomplish my goals...
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...IN THE United States, primary care remains a medical model. This is in contrast to much of the world, where the 1978 Declaration of Alma-At a which recognized that attaining health for all also requires interaction from social and economic sectors - is considered standard. Today, there is much buzz about patient-centered medical homes, a concept that promises to transform the practice of American medicine. There is much to praise about this most recent iteration of the medical home. But the missing ingrethent in all these definitions and models remains public health. A population focus that addresses the social determinants of health is an essential component of primary health care. In the United States, such a comprehensive approach has been labeled community-oriented primary care. This model is built firmly on the Alma-Ata principles and incorporates a public health approach to health services. Community-oriented primary care organizes the delivery of health services, around a population, not simply a collection of individuals. It identifies a population - most frequently a geographically defined community - and uses epidemiology and interventions to improve community and individual health and well-being. In this model, both individual patients and the community are the foci of the delivery of health services. Primary health care stands at the intersection of personal and population health services. It requires integrating medical models of primary care that are centered on...
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...completeness of the record. This can result in an increase in scheduled visits per hour with no lessoning of patient care quality. Also, by reducing the burden of administrative work, it allows a healthcare provider to concentrate more on the patient and less on paperwork. By definition, an EHR system is a record in digital format that is capable of being shared across different health care settings. In some cases this sharing can occur by way of network-connected, enterprise-wide information systems and other information networks or exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information. There is much variety of health record software available for medical records. Sharing patient charts and medical information with other health care providers is also made substantially easier with an EMR system. While EMR interoperation is a long term goal and one not realized yet, it is possible to select patient information, including...
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