...How to Start a Medical Billing Business A Research Paper For: Medical Billing Mr. Edgar Raule Prepared by Osary Rodriguez MO1 September 5, 2012 This has been a successful business for me in the first year I did not make a lot of money but I did not loss any money at all. Opening a medical billing office is not to easy but with correct person working with you and dedication to do your best job anything is possible concentration is key to do a correct job. In my case my dedication is everything I open a small business of medical billing. My clients are so satisfied with job that I’m making more money through the years and in the future I will make my business a bigger office and hired more employee to better serve the medical billing industry. They are different ways to start a medical billing business but first you need to know what medical billing is all about. Medical billing is the of receiving payment from the insurance companies to the health care provide for my services done to the patient. In this paper we will learn how to create a medical billing business, how to manage the business the expenses, investment and how we can make some profit from the business. Before you start a medical billing business the primary thin you need to know is to be organized that is one of the ways you can be successful in the medical billing business. When you first start planning a business you need all the basic before you begging your business here are a list of what I will need to...
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...College COMM115: Information Literacy & Research Mr. Titus February 19, 2016 Professional Plan Growing up I have always said that I wanted to be a superhero, I always wanted to help ours. Therefore, when I started 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...
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...Smith Independence University HCA 542A Mod 11:2011 8wk-online Final Paper October 10, 2011 HIPPA This paper will begin with a brief background and history on the Health Insurance Portability and Accountability Act (HIPAA). Following the background will be details about issues that are address within the Health Insurance Portability and Accountability Act. The purpose of this paper is to provide a foundation with providing some information about HIPAA. Background The Health Insurance Portability and Accountability Act (HIPAA) was enacted by Congress in 1996 in response to several issues facing health care coverage, privacy, security and fraud in the United States (ALL THINGS MEDICAL BILLING, 2011, para. 2). Before HIPAA, rules and regulations varied by state, there was no real consistency. Also, there was confusion as to which regulations were applicable and to whom. Did the rules apply in the states where the organization was doing business or where the organization was based? There was also no uniformity between state and federal requirements (ALL THINGS MEDICAL BILLING, 2011, para. 3). With regard to privacy, there were numerous uncoordinated federal acts which addressed privacy in some form. Prior to HIPAA, there was no standard authority for enforcement of fraud and abuse that applied to state and federal health care programs (ALL THINGS MEDICAL BILLING, 2011, para. 4). Congress recognized the increased use of electronic...
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...Public healthcare services are administered by different regulatory authorities in the United Arab Emirates. The Ministry of Health, Health Authority-Abu Dhabi (HAAD), the Dubai Health Authority (DHA) and the Emirates Health Authority (EHA) are the main authorities. Ministry of Health and Emirates Health Authority The Ministry administers a number of federal healthcare laws, including (i) Federal Law No. 5 of 1984 (regulating the licensing and registration of physicians, pharmacists and other healthcare specialists within both public and private healthcare establishments); (ii) Federal Law No. 7 of 1975 and Federal Law No. 2 of 1996 (defining the specific requirements for establishment and licensing of public and private medical laboratories, clinics and hospitals in the UAE); and (iii) Federal Law No. 4 of 1983 (governing pharmaceutical professions and establishments and the import, manufacture and distribution of pharmaceutical products). The Ministry oversees the Northern Emirates healthcare system (the Northern Emirates include Ras Al Khaimah, Ajman, Umm al Quwain, Sharjah and Fujairah). Some of the Northern Emirates recently started establishing new healthcare institutions or reforming existing ones. Sharjah, for example, established the Sharjah Health Authority by Sharjah Amiri Decree No. 12 of 2010. The Ministry, however, still invests substantial efforts to improve the level of healthcare services in the Northern Emirates. The projects announced...
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...Bill suffered a fractured vertebra, a broken arm, and multiple tears along his back and shoulders. He also received cuts and bruises on his face. Bill has accumulated many medical expenses since the accident and now he is bringing an action against the county and state for his injuries, lost wages, and loss of consortium. Your firm has been retained to represent Bill. By the time you enter the case, Bill is back to work, and he is hard at work finishing up his memoir. He is continuing to incur medical expenses. However, some of the charges have inadvertently been charged to his HMO plan rather than being held out for payment as related to the litigation. You have been asked to calculate the medical expenses and manage the billing of the services. You contact the doctor’s office for Bill’s medical records (with his permission and HIPPA consent) and the billing statements. You also contact Bill’s HMO and ask for their records of services billed. While you await the medical records from one of Bill’s doctors, you decide to do some sleuthing regarding the “typical” costs for various services related to the medical care that Bill received as a result of his accident. You know the agreed to fees have been negotiated as a result of the litigation, but you think that some additional research can’t hurt. The medical records arrive by courier from the doctor’s office (your firm is charged $100.00 for the courier service) and you receive the fax from the HMO. You begin your analysis and...
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...are the process of healthcare finances. Patient accounts are the elements, data flow is the process, and charge capture is the outcome. The relationship between patient accounts, data flow and charge capture is as follows: in order to provide competent medical billing and collections services in a timely and cost effective manner that will maximize the reimbursement revenue at a competitive market price. This guarantees that 98% of claims are paid on first submission and electronic claims are paid within 5 to 14 days, and payments are recovered on aged claims within 30 days . List two reasons why the HIM Department reviews patient medical records. To make sure the information is complete and accurate and ensures all the necessary forms are complete and signed - sort of a quality assurance function. The HIM department may also review patient records for other reasons such as audits, to determine trends, to respond to or resolve billing or legal issues. Research and education is another reason for medical record review. This would be to analyze clinical data on disease patterns and treatment, determine the results of treatments, survival rates, etc. 3. Why is the billing process important? Explain. The medical billing process is important because it's...
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...visible. It is estimated that fraudulent billings to both private and public health care programs are between 3 and 10 percent of total health care programs expenditures. The most recent Centers for Medicare and Medicaid (CMS) statistical estimates project that total health care expenditures are estimated to total $2.4 trillion, representing 14 percent of the gross domestic product. By the year 2016, CMS also estimates that by the year 2016, the total health care spending is to exceed $4.14 trillion, representing 19.6 percent of the GDP. As one can see, the tens of billions of dollars lost due to health care fraud is a serious financial issue that affects the healthcare system as a whole and affects patients, taxpayers, and government through higher health care costs, insurance premiums and taxes. Health care fraud is defined in Title 18, United States Code (U.S.C) s. 1347 as “whoever knowing and willfully executes or attempts to execute a scheme or artifice to defraud any health care benefit program or to obtain, by means of false or fraudulent pretenses, representations or promises, any money or property owned by or under the custody or control of, any health care benefit program.” In other words, it is intentional deception of health insurance claims to gain an inappropriate payment or benefit. Health care fraud is challenging to control due to the uniqueness of the health care system where most billings claims are submitted by the medical care providers and not by the insured...
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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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...UNDERSTANDING MEDICAL INSURANCE KEY TERMS Step 1 S te St ep 10 Follow up payments and collections Preregister patients p2 Establish financial responsibility St ep 3 S te p 9 Generate patient statements Check in patients Monitor payer adjudication Review coding compliance St ep 8 S te Check out patients Review billing compliance p7 St ep 5 S tep 6 Learning Outcomes After studying this chapter, you should be able to: 1.1 Explain how healthy practice finances depend on correctly accomplishing administrative tasks in the medical office. 1.2 Compare coinsurance and copayment requirements for health Copyright © 2014 The McGraw-Hill Companies plan benefits. 1.3 Identify the key steps in the medical billing cycle. 1.4 Discuss the impact of electronic health records on clinical and billing workflow. 1.5 Evaluate the importance of professional certification and of medical liability insurance for career advancement. S te p4 Medical Billing Cycle Prepare and transmit claims 1 accounts payable (AP) accounts receivable (AR) benefits cash flow certification coding coinsurance copayment covered services deductible diagnosis documentation electronic claim (e-claim) electronic health record (EHR) fee-for-service health care claim health information technology (HIT) health plan indemnity plan managed care managed care organization (MCO) medical assistant ...
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...Outline In deciding to become a Medical Administrative Specialist, a person should research the job description, the requirements to become one, and the job outlook for the future. 1. Job Description A. physician practices; large healthcare and allied health organizations such as clinics, hospitals, and foundations; insurance companies; medical publishers; research organizations; and medical product manufacturers 2. Requirements A. Education 1. Associates Degree 2. Total of 68 credits B. Training 1. Internships 2. On-the-job 3. Job Outlook A. Various fields 1. Medical Transcriptionist 2. Insurance Billing B. Expected growth Medical Administrative Specialist In today’s job market of limited opportunities, it is necessary to choose a career path wisely. One sector of the economy with high growth prospects is the medical field. As such, a career in Medical Administration would appear to be a promising choice. However, there are many important aspects that must be taken into account before choosing to follow this career path. These aspects include salary, the large number of available jobs, and the job outlook for the future. When choosing a career, salary isn’t always the first thing to look at, but of course, should be considered. The pay varies greatly in the Healthcare Administration category, since there is a wide range of jobs. An entry-level professional who possesses an Associate’s in Healthcare Administration...
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...0 3 0 Electronic Health Records in the Physician Office CHAPTER OUTLINE Patient Flow in the Physician Practice Step 1. Pre-Visit: Appointment Scheduling and Information Collection Step 2. Patient Check-in and Payment Collection Step 3. Rooming and Measuring Vital Signs Patient Examination and Documentation Step 4. Patient Checkout Step 5. Post-Visit: Coding and Billing Post-Visit: Reviewing Test Results Coding and Reimbursement in Electronic Health Records Computer-Assisted Coding Clinical Tools in the Electronic Health Record Decision-Support Tools Tracking and Monitoring Patient Care Screening for Illness or Disease Identifying at-Risk Patients Managing Patients with Chronic Diseases Improving the Quality and Safety of Patient Care with Evidence-Based Guidelines E-Prescribing and Electronic Health Records Keeping Current with Electronic Drug Databases Increasing Prescription Safety Saving Time and Money LEARNING OUTCOMES After completing this chapter, you will be able to define key terms and: 1. 2. 3. 4. 5. 6. 7. 8. 9. List the five steps of the office visit workflow in a physician office. Discuss the advantages of pre-visit scheduling and information collection for patients and office staff. Describe the process of electronic check-in. Explain how electronic health records make documenting patient exams more efficient. Explain what occurs during patient checkout. Explain what two events take place during the post-visit step of the...
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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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...0 3 0 Electronic Health Records in the Physician Office CHAPTER OUTLINE Patient Flow in the Physician Practice Step 1. Pre-Visit: Appointment Scheduling and Information Collection Step 2. Patient Check-in and Payment Collection Step 3. Rooming and Measuring Vital Signs Patient Examination and Documentation Step 4. Patient Checkout Step 5. Post-Visit: Coding and Billing Post-Visit: Reviewing Test Results Coding and Reimbursement in Electronic Health Records Computer-Assisted Coding Clinical Tools in the Electronic Health Record Decision-Support Tools Tracking and Monitoring Patient Care Screening for Illness or Disease Identifying at-Risk Patients Managing Patients with Chronic Diseases Improving the Quality and Safety of Patient Care with Evidence-Based Guidelines E-Prescribing and Electronic Health Records Keeping Current with Electronic Drug Databases Increasing Prescription Safety Saving Time and Money LEARNING OUTCOMES After completing this chapter, you will be able to define key terms and: 1. 2. 3. 4. 5. 6. 7. 8. 9. List the five steps of the office visit workflow in a physician office. Discuss the advantages of pre-visit scheduling and information collection for patients and office staff. Describe the process of electronic check-in. Explain how electronic health records make documenting patient exams more efficient. Explain what occurs during patient checkout. Explain what two events take place during the post-visit step of the visit workflow. Describe the advantages of computer-assisted...
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...with the growth in technology and resources, charts are being documented electronically in a computer driven format. This helps with billing, patient data, storage, and use evidence towards their treatment plans. The electronic medical records (EMRs) are going to change the way many people live or how many people are treated. EMRs are changing the way many health care facilities function. This is why I decided on the topic of health records in electronic format. The new computer formatting is going to change how medicine is practiced, communicated with other providers, and how billing is processed. EHRs are designed to help make health care facilities function easily and quickly. According to Fetter (2009), EHRs are to have eight functions. They are health information data, result management, order management, decision support, electronic communication and connectivity, patient support, administrative processing and reporting, reporting and population health. These eight functions are necessary in my work facility. I work in an outpatient physical therapy office. We use and electronic system called Therapy Source. Therapy Source gives us the tools for electronic communication and connectivity, and administrative processing and reporting. Therapy Source allows us to input patient data, put in over the counter payments, do billing and charges, and note documentation for patient treatments. We do use another source for result management, decision support, and reporting...
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...determined that a capital expenditure of an installation of electronic medical records (EMR) will help their facility compete with surrounding facilities. The cost will be roughly $50,000, and will consist of the hardware, labor, software, service, and education for facility staff. This paper will confer that attainment of electronic medical record hardware and software will facilitate organizational and management with facility goals based on the necessity of the facility to compete with other facilities in the area that are technically advanced. In the long run the facility will reap the rewards of the installation of this new technology. Management Goals Productivity The chief goals of the administration group at Client Health and Rehabilitation Center is that of productivity. With the organization becoming further advanced technologically owing to the use of the EMR system, responsibilities that consist of procuring doctors orders for updating, filing, and charting additional redundancies, and use many paper charts will not be necessary, thereby doing away this outdated responsibility. Acquiring information for chart audits to determine code status, new doctor orders, and accurateness of assessments will be completed with simplicity. The management team understands the need to put into practice the technology with a crossing point to the finance office. Billing and collections will advance and make more efficient conformity...
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