A Brief Note On The Medical Insurance Specialists

1- Employers possess limited budget to fund employee benefits. From an employee's perspective, which employee benefits practices should be funded? Which are easily dispensable? Now respond to these questions as an agency or company representative?

plan, if the more frequent care calls had not helped then the individual may benefit from

Health insurance in the United States is a highly politicized issue. In recent years, many strides have been made to extend health insurance coverage to all Americans with the passage of the Patient Protection and Affordable Care Act (PPACA). While the program has been vigorously debated in the public realm, arguments are often centered around political ideology rather than economic theory. This paper seeks to challenge the entire structure of the current health insurance model, since its inception in the 1950s. Through the overuse of a third-party payer model, a magnitude of problems have emerged that severely diminish the efficiency of health care allocation in the United States. This paper proposes a model that seeks to correct issues of cost, access, and market efficiency by adapting the Medicare Part D payment scheme for an all encompassing insurance model.

Sue McConnell, a smart straight ‘A’ student gets invited to the plan. She has a huge crush on Dave, so she’s in for it. The group gets her involved by asking her to request a meeting with Mr. Griffin. After the meeting, the group plans to kidnap him to scare him.

2 Be able to present a reasoned case for changes in staffing resources, identifying personnel requirements

The board of directors and the president know that they have serious human resource issues that will have to change in order for them to compete in the local healthcare market as an employer-of-choice. As in any healthcare organization, fiscal resources are limited, but the board is firmly committed to investing in a well developed human resources plan to decrease turnover and stem the ever-growing turnover and vacancy rates. The president has asked you to attend the next board of directors meeting to share your plan for addressing these serious issues. What will you tell them in your presentation to address the retention and recruitment problems? (Points: 5)

The Vigo County Tax & Municipal Services Office has been suffering from a decrease in workplace coherence, because job descriptions have not changed with advances in technology and added responsibilities. Janie, the receptionist feels overworked because she feels like she is doing most of the clerk’s job, while the clerk’s have free time. The clerks, Myra and Johnny, acknowledge they have free time. However, they feel they take care of database admin duties without being compensated for the extra responsibility. Alistair, the database admin, is content with his position, and sees nothing wrong with his present situation.

One financial problem the healthcare industry is facing right now is healthcare collections. Healthcare collections have always been a financial problem to healthcare industries because of nonpayment from the uninsured and individuals who are uneducated about their health plans. Nonpayment to healthcare industries means a loss of revenue. A loss of revenue means that health care industries may run the risk of exhausting their financial resources and become unstable. This financial problem is very typical in the healthcare industry.

There are four areas that offer home health care services but operate independently of each other: Banner Home Care, Hospice Care, Pharmacy, and Medical Equipment. Three departments within the company that cover all four areas are Finance, Human Resources and Planning. Despite their independence, each department follows the same home health administrative structure. All new orders begin in the intake department where patient information is gathered, including patient assessments and physician’s orders. The patient’s file is then sent to the scheduling department to determine the best time for the patient and Banner Home Health. Once the scheduling has been finalized, the file is forwarded to the insurance team where the patient’s insurance is verified and prior authorization is established. From there the clinical team takes over and performs the number and type of visits prescribed by the physician. Once the number of prescribed visits has been completed, the file is transferred to the claim’s department where the insurance company is billed for services rendered. Finally, once the claims forms have been sent to the insurance company, the file is sent to the collections/accounts receivable department where the file is monitored until full payment has been received. (See

Plan of action: Client must adhere to the 10pm curfew and to DHS Rules and Regulation. Client must participate in all scheduled meetings. Client must attend to all on-site and off-site medical appointments and provide medical documentations. Client must adhere to the saving contract. Client must provide updated information concerning her legal issue. CM reviewed the Bi-Weekly ILP. Client agreed and signed. Next Meeting is scheduled for

And finally, there is the issue of staff mismanagement. The supervisor, Keith Frazier, is only checking in with this department one to two times per week. Mr. Frazier is aware that Pat is making international phone calls. He is also aware that Pauline found a way for Pat to make these calls from the building’s elevator once he had the phone system modified to only allow internal calls. Mr. Frazier has also been fielding complaints from the accountants about not receiving their tax schedules in a timely fashion. However, he has failed to confront either of these issues. This lack of management can be attributed to the following:

Based on Walter’s situation, I have decided to write the referral for Walter to be listed for a placement, mainly because I think that he is incapable of living safely at home. First of all, relating to the first theme, I have determined that Walter is incompetent because based on his actions, he is unable to look after himself and maintain a safe and clean home. For instance, he does not appear well-groomed and his house is cluttered with spoiled products, multiple objects on the floor, and piles of newspapers on the stove, all of which are safety hazards. Secondly, the next theme is time-sensitive because it can advance the decision making process by taking immediate actions of placing the patient on the wait list. After defining Walter’s

3. You have been asked to advise a growing organisation which employs 75 people in office-based roles but which has no specialist, dedicated HR function. Managers are particularly keen to know how they can best evaluate the effectiveness of their HR activities and initiatives. Despite limited funds being available the organisation manages to provide some form of formal training and development opportunities for everyone each year, gives everyone an annual performance appraisal and seeks to involve staff through a consultative forum which all attend at least once a year. What advice would you give? Justify your answer.

The role of the Medical Insurance Specialist is very important to the financial operation of a doctor practice, hospital or other medical facility. A Medical Insurance Specialist collects all the information necessary to prepare insurance claims, enter patient demographics and insurance information, enter ICD codes and CPT billing codes, research, correct and resubmit rejected and denied claims, bill patients and answer patient questions regarding charges. The billing process is actually the process of communication between the insurance specialist, medical provider, patient and the insurance company. This is considered the billing cycle. The billing cycle could takes days to complete or it could take months.

No. 1: Evaluate John Taylor and Marty Grayson’s effort to identify the opportunity. Are they the right people for this opportunity? Why or why not?