BCBS Case Study

I will do only the patient demographic part and the provider or someone for clinical has to complete the form. I still don't understand why Johana or any MA can complete the patient demographic part on vase of the list that I provide to them but anyway I will do that part so they can't said that our billing department don't want to cooperate on this process.I know we shouldn't not be responsable for this but we need to recovery that

CCIB Intake received referral #1113-8073-1224-4053654 from reporting party (RP) Counselor/Therapist Kristy Bynum with Child Guidance 3628 Stockdale HWY, Bakersfield CA 93309 (661) 322-1021. Former foster child Jacob Daniel Halbrook DOB: 12/09/01 who is the brother to foster child Sharra Russelle Halbrook DOB: 5/23/06. Jacob disclosed that he witnessed his former foster father Jose Borbon in the same room with Sharra while she was dressing. Sharra was observed dressed in her underwear only. Jacob observed this incident as he passed, walking down the hall. This incident occurred approximately 2-3 months

RE: E/M codes 8/5/2015 4:37:46 PM Definitely using the correct E/M code's. Document the code's for reimbursement for medicare, medicaid, or private insurance. Not done correct big lose of money. You make a great point on this one

CCIB Intake received a SOC 341 from reporting party (RP) Melanie Willis regarding and incident with residents Greg Ekdahl and Paige Katler. According to the RP on 1/26/17 at 9AM while being transported via van to Greg's day program (Escuela Del Rio Day Program) a peer sitting behind him was screaming and singing curse words while listen to music on the radio. The RP asked the peer to stop and Greg asked the peer to stop, in addition Greg turned off the radio. The peer (Paige) struck Greg twice on his left shoulder with an open hand in reaction to his turning off the radio stating " he turned off the radio, he deserved that." Greg was examined for injuries; none were found. He was later left at his day

As originally conceived, MTS would have provided HCFA with a single system to streamline Medicare claims processing, integrate data for Medicare Parts A and B, track beneficiary entitlement and insurance information, achieve better financial oversight, and incorporate managed care. As you can see, MTS would have augmented our current fraud and abuse efforts, but MTS also would have fulfilled other goals that were important to HCFA, such as complying with the CFO Act, continuing to make managed care payments, and supporting customer service functions. We are currently reevaluating the appropriate way to continue HCFA's efforts in pursuing these

CCIB Intake received referral number 0560-8525-1774-8086170 from reporting party Amy Rodriguez mother of Penelope Rodriguez on 4/2/16. The reporting party believes the black eye to have occurred from physical abuse do to "personal experience." She believes the black resulted from being hit or by being hit with a toy. The reporting party brought Penelope to a doctor (date unknown) due to the child's hair loss. The doctor suspects the child has Alopecia, however the doctor is not certain about the diagnosis. It was presumed the child's hair was falling out due stress. The doctor advised the child be seen by a specialist to confirm the diagnosis.

The lifecycle of physician-based claim (CMS 1500) is something that we not only need to know, but also how to do from start to finish.

In October 1, 2008, the CMS adopted a non-reimbursement policy for certain "never events, which are defined as non-reimbursable serious hospital-acquired conditions (Sollecito & Johnson, 2013, p. 25). Examples of “never events” include surgery on the wrong body part; foreign body left in a patient after surgery; mismatched blood transfusion; major medication error; severe “pressure ulcer” acquired in the hospital; and preventable post-operative deaths (Center for Medicare & Medicaid Services, 2008)

As for the collection, I would need to know whether there are multiple subjects involved with the projects. Searching by a subject would allow the user to locate projects based on class requirements or interests; these subjects could include biology, chemistry, physics, geology, or engineering. Additionally, I would need to know how the students dated their projects. The database could include dates by month or year to inform the student whether the project was completed recently. Assuming that there are numerous projects with varying difficulties, I would need to know if there are prerequisites and safety concerns. For example, a prerequisite could include knowledge on a particular concept and material or hardware requirements. Lastly, I would need to know the appropriate grade level for the projects, along with a timeframe for completion. This would allow a student to filter their search by the amount of time required to complete a project, which includes several days, weeks, or months. These aspects also correspond with the users’ information needs.

Please note that BCBSIL is not denying coverage for Nasser Shamah to receive treatment with Dr. Klein-Gitelman. We are advising that Dr. Klein-Gitelman is Non-Participating in the Blue Choice PPO network and that the Non-Participating provider benefits will apply. As always, treatment decisions are the responsibility of the patient and the attending physician, not BCBSIL or the Benefit Plan.

* Medicare/Medicaid, to be sure the doctor is not banned from caring for Medicare/Medicaid patients

Would you please correct the patient sliding fee scale information that being entered incorrectly under the patient policies tab. I review the patient household family income ($22,432.41 for 3 family members) and the sliding fee scale level is B and under the patient policies tab the Sliding fee scale was selected as a Scale A and this is incorrect . You FWD message to the billing pool and PMG FWD back to the billing department b/c the information don't match. Please do the appropriate corrections and email me back so I can advise PMG.

If the Centers for Medicare & Medicaid Services (CMS) change their payer regulations and accreditation requirements, hospitals would need to accommodate their requests for continued supplemental payments. In other words,

Yes I'm using that. The problem is that PMG return one claim saying that the DX code that the provider select is not a valid Dx code and Medicare don't cover Diabetic code and I think that is not correct. I review the denial from MCR and the reason of why the payer denied the claim is b/c they said that the provider is not credential with Medicare and that's why I want to confirm with you before me told PMG that they need to FWD the claim back with support message on claim saying that the provider is credential with MCR and the effective date on claim.

v. Bausch & Lomb Inc., the court was tasked to decide if the post-closing price dispute provision controlled the seller’s objections or if the objections fell under the indemnification arbitration provision. The court reasoned that since the post-closing price dispute provision clearly set forth that the expert accountants shall “determine on the basis of Accounting Principles whether and to what extent, if any, the CNOAS requires adjustment,” the dispute provisions applied to the seller’s objections, which claimed incorrectly recorded values on the CNOAS. The court went on to find that even though the language of the post-closing price dispute provision did not refer to the expert accountant procedure as a valuation or appraisal, the agreement clearly provided for a third party to determine the controversy via a specific procedure which is allowed under N.Y. CPLR §