.../202/MH01799/new74598_disk1of1/0073374598/new74598_pagefiles FROM PATIENT TO PAYMENT: 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...
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...Legal and Ethical Practice Health care professionals are held to legal standards, as well as high standards of ethics which govern their practice. This chapter will introduce the student to the basics of health care ethics and legal practice. Ethics Ethics are the practices, beliefs, and standards of behavior that guide practice as health care professionals. Four basic ethical principles: Autonomy refers to the right to make one’s own decisions. Health care professionals must respect a patient’s or client’s right to make decisions, even when the professional disagrees with the decisions or it may not be in the client’s best interest. Nonmaleficence means to do no harm. This principle is the basis for most health care codes of ethics. Harm...
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...ENGL205-1201A-06 Technical Writing and Speaking Phase 4 Individual Project Preparing a Procedure Manual Kelley Auxier February 6, 2012 MEDICAL RECORD PROCEDURES HEARTLAND HEALTH COMMUNICATIONS Volume 2 Kelley Auxier Heartland Health Communications Revised February 7, 2012 Table of Contents Heartland Health Communications……………………………..1 Table of Contents……………………………………………………….2 Mission Statement……………………………………………………...3 Objectives………………………………………………………………….3 Chapter 1……………………………………………………………………….4 Purpose and Function of a Health Record……………………………………..4 * Patient care management * Financial and administrative processes * Patient self-management Maintenance of the health record………………………………………...5 What is a medical record used for………………………………………..5 Who can document in the chart…………………………………………..6 Chapter 2………………………………………………………………….7 Medical Record Department Responsibilities…………….........................7 Medical Record Departments major functions……………………………7 Retention of Medical Records…………………………………………..8-9 Glossary…………………………………………………………………10 Acknowledgements………………………………………………….......11 Introduction: This procedure manual will help properly train the staff on how to maintain a medical record. This includes medical office assistants, nursing homes, administrators and medical billing specialist. The reason for the manual is for medical/health record workers to develop and manage the records more effectively and efficiently. After...
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...gloves during a procedure. Education of Cath lab nurse In order to perform the role of a cath lab nurse, one should possess a nursing degree, and a registered nurse license. A RN may opt to merely specialize in cath lab nursing. According to the not-for-profit, Cardiovascular Credentialing International, Inc. (CCI) website, a cath lab nurse should obtain the RCIS examination and credential. “CCI administers the Registered Cardiovascular Invasive Specialist (RCIS) examination. This credential has been recognized by our own society (the Society of Invasive Cardiovascular Professionals, or SICP) as the only credential for professionals working in cardiac catheterization laboratories that tests for all of the knowledge and skills that are necessary to do so.” (cathlabdigest, 2015). Role of the Cath Nurse Patient Assessment and Preparation Registered nurses who work in a cardiac catheter laboratory assist physicians with patient assessments. This includes task such as ensuring that the patient’s chart and records are updated, helping the patient to overcome fear by answering questions regarding the cardiac procedure. Patient education in a cath lab is important, since Cardiac cath lab nurses prepare patients for catheterization, angioplasty, pacemaker implantation and cardiac procedures. Preparation of patients can include taking the patient's vital signs, oxygen levels and heart rhythm before the physician examines the patient. Patient Education...
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...NUR 159 Class Information and Procedures B-1 NUR 159 Class Information and Procedures NUR159ClassInformation 3/10/2014 NUR 159 Class Information and Procedures B-2 CLASSROOM BEHAVIOR Refer to Classroom Behavior in Student Nurses Handbook TESTING INFORMATION AND PROCEDURES 1. Silent Test Reviews: Silent test reviews will be conducted after each test. Refer to Test Security in Student Nurses Handbook for further information on test reviews. Students may also schedule individual test reviews with their seminar leader. 2. Test Make-up Policy: Refer to Test Security in Student Nurses Handbook for further information on test make-up. 3. Make-up of Final Exams: In the event that a student misses the final exam for the nursing course, the student will receive a grade of incomplete or “I” for the course. Refer to the Course Grades policy found in Student Nurses Handbook. 4. Collaborative or Group testing activity: An opportunity to add a maximum of two points to individual test scores may be earned through a group testing activity. Two points will be added to individual student scores if the group activity score is 91 and above. One point will be added to individual student scores if the group activity score is 81 through 90. No points will be added to individual student score if the group activity score is 80 and less. Group testing will be conducted as follows. a. After taking the exam, individual test scantrons will be collected. The students will keep the test booklet...
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... Establishing a HIPPA Compliant Procedure at Healthcare Department of Gary Job Corps Center Definition: Healthcare industry is being faced by a major threat that is misuse of patient health information. To protect the patient and their families during their job transition or the unemployment period and to protect the patient health information from being misused the U.S Congress ratified HIPAA i.e. Health Insurance Portability and Accountability Act. HIPAA protects patients and their families in times of their unemployment by providing them with Health Insurance at that particular time. (Wikipedia, 2011) The area of study this research addresses is the health care industry and the processes within. Healthcare industry is one industry that is always successfully operational because human being is exposed to the threat of illness every second. Since health care industry is always operational, the competition within the industry is extremely high. The competition is not only about who provides the best services, but it is also about who provides the best protection to the patients in terms of managing their information as well as protecting them in times of need. The subject under consideration is to study the health department of Gary Job Corps Center and develop a procedure that is compliant with HIPAA. The procedure in focus will be the management of patient health information and its security maintenance in compliance...
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...Psychological factors such as behaviors due to chronic pain, stress, depression, and cultural beliefs can have an adverse affect on the body’s physical condition making the treatment of both the patients’ psychological and physiological aspects of health crucial in increasing the success of the patient’s treatment outcomes, one’s adherence to medical regimens and maintaining and improving one’s wellness. Therefore, in the attempt of improving overall patient health, measurable by shorter hospitalizations and improved adherence to medical regimens, a psychiatry division comprised of five specialists specializing in substance abuse psychology, inpatient-only psychology, child psychology, adult psychology, and pain management has been developed with the responsibility of improving patient health through the use of psychological methods. The implementation of these methods are targeted to concentrate on the weaknesses and strengths of those needing psychological help in the hopes of improving the health and well-being of all those involved. Substance Abuse Counselor The substance abuse counselor is one, which helps individuals dealing and suffering from a variety of different addictions such as those of alcohol and drugs. The substance abuse counselor is to counsel individuals who are addicted to these substances, helping him or, she to identify and understand the behaviors and problems associated with his or, her addiction. Addiction can become a very debilitating disorder...
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...Medical Technology and U.S. Health Care Medical Technology and U.S. Health Care Over the course of history, medical technology has continued to evolve in more ways than one. The advancements in surgical procedures, imaging techniques and the use of computer technology has allowed for patients to receive health care in a more convenient and efficient way, but with this convenience and the ever evolving technology comes the burden of cost on the U.S. economy. This paper will review how early medicinal practices have evolved into the technologically advanced world of medicine we live in today, as well as discuss how these advancements play a role in the accessibility, affordability and quality of life and care the patients of the United States receive today. In the early 1800’s, medicinal practice in the U.S. was considered to be very primitive. Unlike the European countries of Britain, France and Germany, “American medicine lagged behind in the advances of medical science, experimental research and medical science education” (Shi & Singh, 2008 p. 85). Instead, America focused more on applied science rather than the research of basic sciences. In return, the United States’ “early practices of medicine were regarded more as a trade than a profession. It did not require the rigorous course of study, clinical practice, residency training, board exams and licensing, without which it is impossible to practice today” (Shi & Singh, 2008 p.85). This meant that pretty much...
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...performing as well as countries such as India or Thailand, and also to provide insights on how to go about leveraging on certain medical procedures that China have a comparative advantage in performing. This study resulted in two findings. Firstly, there is a lack of hospitals with JCI accreditation which we found out was due to a lack of motivation from public hospitals to do so, and also a lack of transparency in the management of the Chinese hospitals. Secondly, we found that the three medical procedures with the biggest potential to spearhead the success of medical tourism in China are Heart Bypass Surgery, Hip Replacement Surgery and Traditional Chinese Medicine. Keywords: Medical Tourism China JCI Contents Page Chapter 1 Introduction 1 1.1 What is Medical Tourism 1 1.2 Reasons for the popularity of Medical Tourism 2 1.3 Why do patients seek care at medical tourism destinations? 4 1.3.1 Low Cost 4 1.3.2 Avoid Waiting lists 6 1.3.3 Procedure not available in home country 6 1.3.4 Procedures unavailable or restricted by society and/or legal system 7 1.3.5 Tourism and vacations 7 1.3.6 Privacy and Confidentiality 7 Chapter 2 Global Market overview of Medical Tourism Industry 8 2.1 Rise of Asian Medical Tourism demand 9 2.2 Medical Tourism Facilitator / Agents 10 2.3 International Medical Procedures Costing 10 2.4 International Healthcare Arbitrage 12 2.5 Problems pertaining to Medical Tourism 13 Chapter 3 Medical Tourism...
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...the video “"Debunking Health Care Myths” was selected. The video is an interview with David Goldhill the Author of “How American Health Care Killed My Father”. In this video he discusses the increased costs of health care along with the alarming numbers of hospital acquired infections death rates including his personal in sight and view point with the health care industry involving the treatment of his father and the infection that took his life that he acquired while in the hospital. His insight comes from a focus on the view point of a patient and a person who runs business outside of health care. Importance of shifting health care focus from Output to Outcomes Risa Mourey in the ‘A Sea-change for Health care’ video emphasized the need to shift health care focus from output to outcomes. Output refers to the different treatment procedures clinician’s use on a patient and outcome refers to how the patient felt after the treatment was administered and staying healthy there after. This shift is crucial because regardless of how sophisticated or complex a treatment procedure is, the end result which is how effective the procedure was to curing the patient is all that matters. If the health of the patient improves as a result of that treatment procedure then we can consider it a success. However, the measure of success must also be linked to the cost and the side effect of that treatment procedure. There are many examples where treatment procedures have unreasonable price...
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...Advocacy is an important role nurses must take for their patients. One example Makary (2012) provided was a nurse who will administer a medicine even if she believes it was ordered incorrectly, because that hospital...
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...Leadership Standard (Joint Commission Perspectives, 2013). Further review indicates that miscommunication is associated to the other 5 findings, as well. Noguchi (2013) discusses medical errors resulting from miscommunication, adding that medical errors may rank as the third leading cause of death in America. For the purpose of this executive summary, the focus will remain on Leadership standard LD.04.01.05 and its direct finding that hospital leaders did not effectively communicate a functional screening criteria policy to staff nurses. Nightingale Community Hospital (NCH) currently utilizes a pre-procedure hand-off form and site identification and verification process/policy to ensure that correct patient, site, and procedure is completed in surgery. The pre-procedural hand-off is a detailed checklist that aids the nurses from hand-off to accepting patient prior to a procedure. Although detailed, several key items are not present on form, making it possible for nursing staff to not clearly articulate expectations of process. The format is yes/no check box with option to elaborate more on only a few items, like medication, do not resuscitate status, and primary language. The option to be more detailed on communication hand-off is an area of opportunity for improvement. Please see other items...
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...removing a cannula whilst undertaking my placement in an out patients department at a local trust. I will be reflecting on the importance of infection control in maintaining the health and well- being of patients. My placement was in a clinic where intravenous transfusions took place for a variety of illness. Most of the illnesses that the patients were suffering from need infusions that could compromise their immune systems. In view of this, it is very important that infection control be adhered to whenever carrying out clinical procedures on the patients. During the course of my shift, my mentor asked me to remove a cannula from a patient whilst under her supervision....
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...Preregister Patients The first step in the cycle is to gather information so patients can be preregistered before their office visit. This information includes the patient's name, contact information, the chief complaint, and whether the patient is new to the practice. The information is obtained over the telephone or via the Internet, if the practice has a website. Step 2: Establish Financial Responsibility for Visit Most patients are covered by some type of health plan. While scheduling the appointment, it is important to determine whether the patient has insurance and, if so, to obtain the identification number, plan name, and name of the person who is the policyholder. Once the insurance information is obtained, the patient's current eligibility and benefits are verified with the payer. Verification may be done by telephone, but most often it is done via the Internet and takes a matter of seconds. It is also important to make sure that the health plan's conditions for payment, such as advance approval requirements for particular treatments or procedures, are met before treatment is provided. In addition, physicians usually participate in some health plans and not in others. If the physician does not participate in the plan, the patient may be liable for all charges. All of this must be determined and communicated to the patient before the appointment. Step 3: Check In Patients When patients arrive in the office, they are asked to complete or update patient information...
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...disease information or procedure information for clinical information; The coding system assist with reimbursement of services provided by facilities. • The most important aspect of ICD-9 coding system is it defines disease in category allowing medical personnel to determine diagnosis, disorders, and procedures incorporating patient data and can assist in utilization process. CPT- Current Procedural Terminology- CPT is another coding system to document medical services, surgical procedures, and diagnostic procedures. CPT codes are HCPC codes that can identify what has been done to a patient to assist in the diagnosis and prognosis of the patient by physicians, billers, coders, and administrative personnel. • The importance of CPT codes is it is a uniformed coding system for medical personnel to document accurately and maintain records for billing and diagnostic purposes. CMS- Centers for Medicare and Medicaid Services- An agency within the Department of Health and Human Services that administers the Medicare and Medicaid program and standards for HIPPA. • The importance of CMS is it provides the different standards that Medicare and Medicaid providers must adhere to. CMS-1500- Health Insurance Claim Form- Health insurance claim form physicians and facilities use to process procedures and services rendered to patients. • The importance of CMS-1500 is that medical providers are able to document what was done to patient for diagnostic purposes...
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