CMS-1500 Health Insurance Process Report

The Affordable Care Act was signed into law March 23, 2010 by President Barack Obama; however, the constitutionality of the law remained in question. In a controversial 5-to-4 ruling, The U.S. Supreme Court upheld the law on June 28, 2012. The ACA is thought by some as the United States health care rescue, and as its downfall by others.

Over the past decade, government operated and privately owned health care organizations have made improvements identifying patient disabilities, discovering alternative treatments at the patient’s discretion, identifying the cause of diseases, and discovering lifesaving cures. The current United States health care delivery system has undergone enormous changes throughout the years. People the United States utilize health care services for many reasons: to prevent disease, to prevent future illnesses, to eliminate pain, and promote a healthier lifestyle to patients. The Patient Protection and

Indemnity insurance is nice in the aspect that you get to choose your health care provider as well as you will be reimbursed for you services that you received. I know that most people couldn’t afford that right away and with

The process of developing of an insurance claim will be essential to the healthcare and medical business. And all starts when the patient makes a call to a healthcare provider;s office then makes an appointment. The assigned administrative staff or workers makes certain if the patient is new requesting an initial appointment or an established patient returning for more or additional services required from the provider. Now the pre-clinical interview

Patient Accounting and Practice Management systems are designed to help health care medical practices are to improve the quality of care, cut cost, reduce risk, and increase revenues. When it comes to the size of a medical practice from small, or to a large medical practice, multi-location group this will feather the system to allow in creating and maintaining a patient billing information much faster and more efficiently then it was ever before. Medical Assistants are able to enter a patient information and post any changes much faster and more accurately with the use of a simplified medical billing software that promotes physician acceptance and much greater investment protection that provides faster insurance reimbursement and to improve

Select one (1) project from the working or educational environment of your choice and specify the main work process (e.g., suppliers and customers involved, work flow, etc.) of the project that you have selected. Next, suggest at least two (2) actions that a manager can take in order to improve the work process of the project in question. Provide a

HIPAA requires two designate coding system to be used to report to private and public payers; this is HCPCS and ICD-10. This coding system is primarily used in the United States and it is used by healthcare providers, including physicians and hospitals. Icd-10 is useful for reporting inpatient and HCPCS is used for procedure reporting for outpatient service and they are both assigned to DRG group. Once the health service is performed, charge captures are slips that are posted to a patient’s account that is processed as a batch order system. The key to the ordering system and charge capture is the “charge code” which is then reflected each service, procedure, supply item or drugs in the chargemaster (CDM). Medical claims fall into one of two types: CMS

* To create a presentation with valid proposals and recommendations to be shared with senior leadership team, by the end of February

On October 1, 2015, Ms. Booth was approved for Medicaid coverage through the BCC program. It was determined by the Mississippi State Department of Health that Ms. Heigle was eligible to receive Medicaid coverage for two (2) years or during the course of her treatment for breast cancer. The Office of Eligibility issued a Notice of Adverse Action on September 5, 2017, informing Ms. Booth that her eligibility would terminate on September 30, 2017, because her two (2) year treatment period was ending.

Tricare is a healthcare program specifically for current and retired military personnel and their families The active duty member is referred to as the Sponsor, and family members are referred to as Beneficiaries.

Having given a brief summary of what this report is going to contain, I will now discuss

To start the physician insurance claim cycle, the offices staff need to have the first encounter with the new patient. In this first encounter the office staff collect general patient information to ensure the new patient eligibility and benefits status. The Information that collect is full name, date of birth, address, insurance policy and reason of the visit. The second step the office start will verify the full benefits of the patient before the first doctor visit to make sure the patient eligibility and to stablish the patient responsibility at the time of the office visit. The day of the visit the patient complete the new patients forms and the office staff ask and make photo copy the patient insurances card and id card for purpose of

One of the aspects of National Correct coding initiative (NCCI) is the application of the procedure to procedure (PTP) coding edits. The PTP code edits are mainly automated prepayment edits which ensure that improper payments do not occur when some codes are submitted jointly for part B-covered services. These edits have since the year1996 been allocated to either the column one or column two Mutually Exclusive or Correct coding file. The NCCI has two main PTP-type code choices which are for practitioners and for hospital. The PTP code edits for practitioners are mainly applied to claims that are mainly submitted by Ambulatory Surgery Center (ASCs) as well as the physicians and non-physicians practitioners. The PTP Edits for hospitals on the

The majority of claims, changes in circumstances and payment validation will be made online using an automated system. The new system will

Resources are in short supply. Costs for research, performance improvement, or quality improvement has to show a return on investment. The final report that results from these efforts has to convey the problem and the results clearly to the intended audience. The written report should show the entire argument and provide the sponsor all the information they need to evaluate the situation. Creating an effective written report will provide concise, clear information, and recommendations that meet the sponsor’s needs. All of the components that make up a report need to be clear and complete for proper communication to take place. This paper analyzes three different research reports that all utilize different presentation styles