DM Medical Billing Case Study

As a manager for a large department her job duties are quite extensive. She manages over forty employees. She reinforces compliance of staff with hospital policies, gives informal/formal feedback regarding performance throughout the year, promotes staff development, and uses effective listening, writing, and verbal skills. She promotes satisfaction targets related to patients, employees, and physicians, actively participates in, and leads interdisciplinary teams. Alicia also assist the director in maintain departmental budget, monitors supply utilization and maintains budgeted targets, and responsible for an efficient and accurate payroll.

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

It is crucial to the success of a practice to have a very personalized relationship with the billing company. The billing company should function as an extension of the physician’s office working toward mutual goals.

In the medical billing revenue cycle, there are ten steps. The first step is patient preregistration where a patient schedules a visit and their insurance is either verified or on file. The second step is to determine the patient’s payment when visiting the provider and the reason for their visit. Next is to check the patient in upon arrival at their visit. This is to verify the insurance and the identity of the patient. The patient is checked out after seeing the provider and charges for services will show on the superbill. After this, the medical biller takes the patient’s superbill and creates a claim. From here, the biller must ensure that the claim is compliant with coding and arrangement. From here, the claim is prepared and finally

To start, I want to talk about what I observed and what I was told a regular day as a medical biller looks like. Mrs. West works five days a week in seven hour shifts. She wears business casual every day. There are not any uniforms required, which allows versatility amongst coworkers. Daily duties of the job include billing claims, filing insurance payments, resolving issues regarding medical claims, and invoicing patients. Each worker, in a business of just three employees, is generally in charge of an entire doctor’s office claims. Mrs. West says that she enjoys owning her own company and being able to help patients, both things that occur daily as a central executive medical biller.

DMD Medical Supplies has positioned itself to capitalize on the future growth of the market by establishing a consistent relationship with both customers service and employee organization. As head office manager, it is my obligation to assure that all employees are able to work expeditiously at an advanced level. In the last three months, it has come to my knowledge that several employees have not maintained this standard. Furthermore because of this discretion, I have created the following proposal for employees Jack Synder and Ruth Disselkoen . The following g executives Frank Daley and Ralph Alane were assigned Jessica Hilo’s workload due to her medical absences. In order to maintain and orderly workload, I have assigned Jack Synder to

There are a limited number of specialties other than EM where the provider serves the undeniable role of determining whether the patient would benefit from hospital admission versus discharge home. Additionally, EM is a unique field in which you work in real-time to follow-up on tests, reevaluate patients, and keep patients, their families, and consultants up to date and involved in the progress of the patient’s evaluation and management. These specific aspects, amongst others, are what I feel separates EM from other specialties and why I am particularly drawn to the

In order to insure each staff member was obtaining their individual and team goals, each member was given their own business (Souza). The tools in which the PFS were given provided them with the tools to prioritize and automate account work lists, sort accounts in various ways and see at a glance their ranking with their work group and office-wide. Managers were given their own dashboard and tools which able them to use query all aspects of receivables for trending purposes and identify problem areas, drill down to the patient account level, monitor revenue, payments, adjustments, receivables, and days for periods from the previous day and week to the previous 18 months, calculate average daily revenue by day and 30-day period, assess their performance for the month to date, and estimate likely results at the month end, view all receivables or select any segment for quick analysis, and generate timely reports on demand, including aging analysis, A/R stratification, discharged not final billed (DNFB) analysis, credit balance analysis, and analysis of problem payers. Finally, a denials management component was implemented in late summer, which will allow registration staff to go online at the end of the year (Souza).

Physicians work to ensure patients have the best health and quality of life, yet they must be paid for the services they perform. Sadly, medical billing can take up a great deal of time and lead to the medical staff feel as if they are being pulled in different directions. For this reason, many organizations now opt to turn to medical billing companies to handle this essential task and doing so can actually increase revenue for the physician and his or her organization. How is this possible?

In the past three months, I have been training in our Minimum Data Set (MDS) department in my work place. As a former floor nurse, it has been an eye-opening experience for me. I had no idea of how nursing documentation reflected the facility reimbursement rate. As nurses, it is so important to take credit for everything you do, this is done by accurate documentation. Our documentation is one of the main contributing factor in The Hospital Value-Based Purchasing (VBP) Program. “The Hospital VBP Program rewards acute care hospitals with incentive payments for the quality of care they give to people with Medicare. This program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they deliver” (CMS.gov, 2017, para. 1). I chose to

Pamela Williams is the Medical Necessity coder I shadowed on this day. Her responsibility as a medical necessity coder is to approve physician orders. When physicians order tests for their patients, Ms. Williams has to verify that CMS will pay for the specific test. In the event the order is rejected, she will contact the physicians. This could be the most difficult part of the job for her. Before she contacts the physicians, several steps would have to be taken. CMS requires a very high level of specificity when submitting orders. The majority of the time when providers are filling out order forms, they are not abiding by the strict guidelines CMS has. It is her job to help the providers reach the level of specificity

Calculate standard adjustments regarding per diem rates to vendor accounts. Analyze payment history in order to resolve outstanding billing issues and reconcile account in a timely manner. Process a variety of vouchers, and audit payments for accuracy. Maintain 99.98% accuracy when calculating and applying discounts, credits and per-diem rates to vendor accounts. Facilitate the budget officers when conducting internal audits by providing thorough documentation of the vendor’s financial history. Responsible for researching, tracking and restoring accounting or documentation problems and discrepancies. Provide assistance to assigned accounting personnel, research and comply basic vendor payment history related with areas of assignment. Maintain the necessary payment records and files to support processed payment transactions. Accurately accessing database in order to locate Medicaid identification, based on patient demographics. Consolidate vouchers and report documentation for batching process, before placing call for courier pickup. Retrieve checks form Auditor’s, matching checks to backup documentation before signing off of pickup.

True Value Medical Billing Services Inc. uses robust and updated technology that’s functioning at its highest level. Providing services for more than just physician clinics, but also providing services for speciality clinics. True Value Medical Billing Services Inc. has outstanding Social Networking skills which is helping to build a larger client base, and the employee turnover is at a minimum maintaining employee stability. Proclaim Medical Billing has a huge employee turnover which is hurting the company's bottom line, they have a small client base which could affect their long-term success. Ideal Billing Services has outdated technology that doesn’t perform at it’s best that will affect their ability to deliver effective services. Ideal

Thank you for your review of my experience for the capacity of Manager, Recognition Programs. I have spent a great deal of focus developing processes and strategic programs to transition into and mirror the Patient Centered Medical Home model. I have partnered with provider and provider group homes impacting the provider and patient experience empowering both parties coming together as joint stake holders and positive outcomes resulting from the care provided.

Linda Grimes is the Assistant Vice President of the Health Information Management Department which means she is in charge. Mrs. Grimes has an RHIA credential and a Master’s. Mrs. Grimes has been working at LMC for eight years and reports to the Chief information Officer. The Facility has undergone a reorganization and will be welcoming a new CFO March 7th. Mrs. Grimes has been a part of many changes at LMC, she was the project manager for the implementation of EPIC the electronic health record system. She was involved in site visits where a team from LMC went to a site that had already implemented EPIC and saw it in motion. Doing the site visit was useful so they could discuss any potential problems that they may experience and