...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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...Steps in the medical billing process The following ten steps will show you the order in which to do the medical billing process: I. Pre-Register patients: patient’s appointments are needed to be scheduled and kept updated. Basic insurance information should be added to the patient’s record, as well as their personal information: age, gender, weight, and height. To make sure no appointments get missed a reminder call should be made. When the patient makes their appointment, ask for an insurance card, copy it front and back then add to the patient’s medical record. II. Establish financial responsibilities for visits: As the patient shows they have insurance: their health plan coverage needs to be reviewed and its eligibility needs to be verified. It is recommended to be sure to ask the patient whether or not if there is more than one insurance company. If this is true, then the first payer should be decided. Once verified and checked that all provisions have been met, steps need to be followed to acknowledge payment for services. III. Check in patients: A new patient who is new to the practice; complete personal and medical information is collected. If the patient is returning their information needs to be reviewed, updated and verified if needed. Insurance cards and identification cards should be copied front and back, and placed in their medical chart. Any office visits that are co-payment dues should be collected at time of service. IV. Check out patients: ...
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...Steps in the Medical Billing Process Annette Callen 02/11/2012 I am writing this paper to discuss the ten steps of medical billing. The ten step process consist of patient preregister, establish financial responsibility for visits, check in patients, check out patients, review coding compliance, check billing compliance, prepare and transmit claims, monitor payer adjudication, generate patient statements and follow up patient payments and handle collections. These steps are under three categories these categories are visit, claim and post-claim; throughout this paper I will explain each of these ten steps. The first category is visit; step one of visit is preregister patients. This step usually involves the clerks at the front desk or nurses depending on the size and location of the health center. The clerks are responsible for checking in patients, scheduling appointments and making appointment reminder calls. The clerks are also responsible for collecting the patient personal and payer information. Step two is establishing financial responsibility for the health visit. This step is where the clerks will collect the payer insurance information, set up a payment plan, and let the nurses and doctors know what is covered by the insurance company such as treatments, testing and medications. If the patient does not have medical insurance then the clerks need to determine if the patient needs to be on a payment plan or if they can pay for the service in one...
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...Steps in the Medical Billing Process Stacy Dickson HCR/220 March 20, 2011 Alexander Mejia Steps in the Medical Billing Process The medical billing process is one that requires attention to detail to ensure that all the proper paperwork is completed properly and accurately. This process will begin form the time the patient enters to register for their appointment until after they have finished their appointment. This paper will provide the step by step process. Visit Step 1 Preregister Patients As part of the medical billing process, preregistering patients is required. This could be scheduling a patient for an appointment or it could be to update a patients appointments. This also allows insurance information to be updated in the patient’s files and to retrieve any demographic information. The medical scheduler will also inquire for the reason of the visit so that the appropriate amount of time is allotted for the visit. Step 2 Evaluate Financial Responsibility Evaluating the financial responsibility of the visit is extremely important, to ensure that the patients insurance covers and what the patients is responsible for. It is also establish if any prior authorizations are required before services are performed. Step 3 Check In Patients When a patient new patient arrives it is necessary to take a copy of their insurance card, drivers’ license, and have them complete a new patient form with their medical history, home address...
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...Merav Nissim HCR/220 February 4, 2012 Natalie Cooper How HIPAA Violations Affect the Medical Billing Process Part Two The global HIV/AIDS pandemic is the worst infectious disease crisis to confront the world since the bubonic plaque halved the population of Europe in the five years after its arrival in 1347. To date, 22 million people have died of AIDS worldwide; another 36 million live with HIV/AIDS today (Fhi360.org). HIV/AIDS is a difficult topic to talk about and even more difficult is the confidentiality that is involved. Many people are hesitant to discuss it with anyone bedides their loved ones. One has to ensure that it stays confidential, and anyone who is not supposed to know should be made aware that it is not to be shared with anyone else. According to the HIPAA Privacy Rule, it is supposed to protect peoples’ private health information. According to CDC.gov, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) attempts to address some of the barriers to healthcare coverage and related job mobility indepediments facing people with HIV as well as other vulnerable populations. There are certain guidelines that aim to ensure that the confidentiality of people living with HIV/AIDS is not compromised when collecting and storing information about the disease. It provides principles, definitions and technical recommendations to maintain confidentiality, privacy and security when working with HIV-related information. Ensuring this...
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...How HIPPA Violations Affect the Medical Billing Process Ronnie Ward HCR/220 02/12/2012 Regina Kraus How HIPPA Violations Affect the Medical Billing Process Through making sure that a patient demographics are accurate and kept confidential HIPPA is able to affect the medical billing process, this authorization which allows a practice to use the confidential information and to bill that patient information to carriers for services should be placed in the patient file. When pertaining to people infected with this deadly and sometimes fatal disease or virus, AIDS and HIV can be a very touching and secretive issue. This is mostly because those who are affected with the disease are fearful of a breach in confidentiality. The patient fear can directly affect his or her health because the patient will not be seeking medical treatment for his or her illness. HIPPA is an organization charged with the responsibility of making sure patient confidentiality is upheld and that the services he or she is receiving is protected. Because of the patient fear of breach in confidentiality, HIPPA has set rules and regulations in place with criminal and civil penalties for those who violate the patient rights and to ensure that his or her right to confidentiality is protected. Patients who are affected with HIV and AIDS information is not separately addressed by HIPPA, never-the-less general guidelines pertaining to the release of personal health information including the HIV status of a...
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...How HIPAA Violations Affect the Medical Billing Process HCR/220 October 7, 2012 How HIPAA Violations Affect the Medical Billing Process In this paper we will discuss how HIPAA violations affect the medical billing process and why HIV and AIDS information is more sensitive than other types of health conditions. We will also examine the social, legal, and ethical ramifications of improper information disclosure. In 1996 on August 21, the Health Insurance Portability and Accountability Act (HIPAA) was enacted by the Federal Government and signed into law by President Bill Clinton (HIPAA – The Health Insurance Portability and Accountability Act, 2011). According to “Health Insurance Portability and Accountability Act” (2012), “HIPAA does the following; provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs, reduces health care fraud and abuse, mandates industry-wide standards for health care information on electric billing and other processes, and requires the protection and confidential handling of protected health information” (What is HIPAA?). The main reason HIPAA was enacted was to protect patient’s personal health information regardless of its severity. Their personal health information is just that, theirs! For that reason, among many other, it is very important to know that a patient’s personal health information is not to be shared with any unauthorized...
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...HIV and AIDS information is more sensitive than other types of health conditions because HIV is often transmitted through sexual activity or IV drug use, sharing of a needle. A diagnosis like HIV or AIDS implies some socially taboo behavior for some individuals. Also, AIDS was initially thought to be a disease unique to gay males and that stigma has stuck throughout the years. We now know that women and children of all ages, sexual orientations and races can also be the victims of HIV and AIDS. HIPAA demands privacy regarding a patient's personal information. That includes diagnose as well as information regarding sexuality and history of drug use. This applies to all diagnoses, but because of the social stigmas mentioned earlier, people are even more sensitive when it comes to HIV/AIDS disclosures. Inappropriately disclosing information can create family and social stress, employment issues and even housing issues. Discussing, diagnosing, and treating HIV/AIDS is a sensitive, private issue between a patient and his or her provider. This privacy is especially important, because any breach of privacy may result in stigmatization or discrimination against HIV/AIDS patients. Patients who are concerned that their health information will not be held private or secure may be discouraged from being tested for HIV and may be dissuaded from pursuing or adhering to recommended treatment regimens. The need for privacy and security must be carefully balanced with the appropriate sharing...
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...HIPPAA Violations Affect the Medical Billing Process, Part Two Amber Padgett HCR/220 October 19, 2014 Felecia Pettit-Wallace The purpose of this paper is to relate to ways that the Health Insurance Portability and Accountability Act (HIPAA) violations may affect the medical billing process. While researching, the findings conclude that confidentiality of health information was adopted centuries ago. The findings of the research show that although, HIPAA laws have been put into place to protect the privacy and confidential heath information of patients; HIPAA laws are sometimes violated. The medical billing coders are sometimes careless when handling confidential information; however medical health records should be protected adequately. The coder that violates the HIPAA laws concerning the confidentiality and privacy of patient health information can suffer serious ramifications. The ramifications of these violations could result in serious penalties such as disciplinary actions by the employer, monetary fines, and jail time, or both. HIPAA violations ranks number one among the complaints received by the Office of Civil Rights each year. Humans take pleasure in the right to privacy in every aspect of life. The right of protecting the confidentiality and privacy of identifiable personal health information takes first priority and is greatly cherished among most. The Hippocratic Oath, dating back centuries required physicians to keep medical information concerning their...
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...HCR 220 Week 9 Final Project How HIPAA Violations Affect the Medical Billing Process To Buy This material Click below link http://www.uoptutors.com/HCR-220/HCR-220-Week-9-Final-Project-How-HIPAA-Violations-Affect-the-Medical-Billing-Process Part One: Resources:Appendix A, Appendix C, and Table 8.3 on pp. 258–259 of Medical Insurance Refer toTable 8.3 on pp. 258–259 of your text to complete the CMS-1500 form, located in Appendix C, according to the following case study: A 67-year-old Medicare patient presents to the office, exhibiting symptoms of HIV infection. After detailed examination, symptoms are determined to be advanced AIDS with manifestation of Kaposi’s sarcoma and other opportunistic infections. Name: James Brown Account Number: 080811 Insurer: Medicare Policy Number: 1098765 ID number: 12345678910 DOB: 02/01/1940 Gender: Male Insured: James Brown Address: 1600 Pennsylvania Ave. Wash. D.C. 60000 Marital Status: Widowed Patient’s Employer: Retired Nature of Condition: HIV, AIDS, Kaposi’s sarcoma Date of Illness: 06/01/2007 Referring Physician: Thomas Glassman, M.D. Physician ID: 1080808080 Federal Tax ID: 5551116679 Dates of Service: 06/01/2007, 06/15/2007, 07/07/2007, 08/01/2007 Procedure: Detailed examination, screening blood panel, pathology services Patient Signature Include ICD (categories only), CPT, HCPCS, and insurance information. If you believe there is insufficient information provided to fill a required field with data...
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... Ten Step Billing Process The ten steps of the medical billing process have been divided into three categories: The visit, the claim and the post claim. Following the billing steps to complete correct claims ensures that providers are paid accurately and timely for services and procedures. The Billing process begins with the preregistration of patients. Collecting personal, basic demographic information, and insurance information and entering that information into the database. All of this personal information can be referred to at any time during the medical billing process. Keeping up to date patient and insurance information makes patient check in more efficient and eliminated potential billing errors. Confirming financial responsibility is the next step in the billing process. Once a patient’s information has been updated in the computer system it is then the medical staffs’ responsibility to determine who will be paying for the services rendered for the appointment. Insurance providers are contacted and benefits are verified as different plans have different levels of coverage. Once the medical staff is aware of what the allowable insurance benefits are, contact with the patient should be made so the patient is aware of their responsibility for out of pocket, non-covered expenses, co-payments, and deductibles. During the appointment, the physician makes notes of the examination and services provided. These notes become part of the patients’ medical records and...
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...Medical Billing and Reimbursement Grand Canyon University: HCA-530-0101 July 14, 2015 Healthcare organizations’ services provided are civic and moral in nature. These services are directly impacting a society and community’s ability to function and be productive. One might say, healthcare organizations must always prioritize the moral objective or vision at all times, however, in order for healthcare organizations to continue providing access to healthcare, these organizations must be financially sound. Revenue stream is one area that initiates an organizations ability or inability to thrive. Billing accurately and timely for these services will ensure revenues are collected avoiding delay in providing healthcare to the community. According to Cleverley, Song, & Cleverley, 2011, p. 14), “Healthcare firms are for the most part business-oriented organizations. Their ultimate financial survival depends on a consistent and recurring flow of funds from the services they provide to patients. Without an adequate stream of revenue these firms would be forced to cease operations”. A critical role in ensuring that there is an adequate stream of revenue in a healthcare organization is the medical coder/biller. This role is tasked to start, process and file a claim to a patient’s insurance (private or government) for reimbursement. These claims are the lifeline of an organization’s revenues and must be process correctly to ensure all services provided will be paid. There are seemingly...
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...to a complicated puzzle which is called Medical Billing Process and HIPAA, ICD, CPT and HCPCS contribute their own uniqueness to the process. HIPAA is the umbrella to the process. HIPAA compliance, as far as protecting the patient’s rights and confidentiality and the physician, has to take place first in the medical billing process. HIPAA influences the medical staff in determining financial responsibility, either as private pay, insurance and personal information who is the responsible party. HIPAA statement has to be signed by the patient, giving authorization for who can obtain their personal information. Then ICD, CPT and HCPCS come under the umbrella each filling a specific area of in the process of medical billing. They are references that are used for certain areas, either by patient billing, physicians and medical facilities. ICD are codes that reference the type of service the patient receives while in staying in a hospital. CPT are numerical codes that are assigned by medical coders and dictate the type of procedures that have been completed on a patient. HCPCS codes are used for outpatient services that physicians or medical facilities use to complete the medical billing process. This is a brief overview of each area, but all of them have to fit like a tight glove to avoid errors in billing. When you look into the advanced purpose of each coding device, you see how complex the medical billing process is and if there are any errors in any of...
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...compliance process is designed to ensure the maximum benefit for health care claims. The compliance process is made up of guidelines set forth by the Health Insurance Portability Accountability Act and by the healthcare staff. These guidelines are setup to protect the physicians, patients, and medical staff. Medical offices can help to reduce errors by making sure that the staff is properly trained and that the office has updated coding and billing software. I think that each office should have a guide that consists of codes which would aid the employees in the billing process. Some offices currently use sheets that are in the front the patients file that contain diagnosis and the codes, which is filled out by the physician. This helps reduce errors in the billing process when the physician completes the code themselves. The Medicare National Correct Coding Initiative is responsible for controlling improper coding and invalid payments for Medicare claims. It is extremely important to correctly link the procedures and diagnoses so that the claim will not be rejected. When claims are rejected due to incorrect linking of the procedures and diagnoses this could result in a loss of money by the physician or the medical facility. When this error occurs claims have to adjusted and then resubmitted, which results in outstanding patient balances due to errors in the medical office. The main implication that occurs form incorrect medical coding is that the medical facilities...
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...MedBill Pros Medical Billing and Claim Services What do we do? We do everything involved to get a doctor paid for their services. This is payment from the insurance company and the patient. But there is more involving the process. The medical billing process is really important to the financial health of the practice, if claims are not submitted promptly, the doctors including us, would not get paid. Submitting Claims The medical biller and coder makes sure all forms are completed and approved and enters the information into the medical billing software, including doctor’s information, patient’s information, insurance information, medical billing codes, payment information, and any special notes on the account. Medical billing codes are necessary for a doctor to be properly reimbursed for the services provided. These codes are some of many: • ICD 9 codes (and ICD 10 codes)- international classification of diseases • CPT codes- current procedural terminology • CPT modifiers- these provide additional information to payers to make sure doctors get paid correctly for services provided • Medicare billing codes- explained for provider services and hospital insurance • CDT codes (dental)- code on dental procedures • NDC drug codes- national drug codes • DRG Medicare codes- diagnosis related group • Taxamony codes- used to categorize a provider or group specialty Our responsibility as Medical billers and coders • Collect the information necessary to prepare insurance...
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