Enrollment And Billing

Romney, M., & Steinbart, P. (2012). Accounting information systems. (12th ed., p. 143). Upper Saddle River, NJ: Prentice Hall.

Double billing is when a patient is billed for the same service more than once. Double billing can occur when there is a product name change and also if there is an error involving the product's software. There are different reasons why a medical claim could be denied. Here are some of the reasons why:

The use of technology in HIM department works out well and effectively. Each patient who is new is assigned a unique medical record number and it always remains the same for the patient each time he/she want to get health care from this health care system. Another system

My career that I am researching for my junior project is Medical Coding and Billing. Medical Coding and Billing are two different jobs. Medical Coding is when a patient has any medical procedure or exam such as going to the doctor for the stomach virus or even going to the hospital for a broken bone. They work with the insurance companies by putting a specific number into the computer. There’s CPT Codes which stands for Current Procedural Terminology which is “ Codes to better understand the services their doctor provided, to double check their bills or negotiate lower pricing for their healthcare services. (About Health, 2014).”

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

The billing for services not rendered for are often done as a way of billing Medicare for things or services, that basically never occurred. This can involve forging the signature of those enrolled in Medicare or Medicaid, and the use of bribes or as Healthcare calls it, kickbacks to corrupt healthcare professionals. Upcoding of services is the act of billing Medicare programs for services that are more costly than the actual procedure that was done. Upcoding of items is also very similar to upcoding of services, but it involves the use of medical equipment. For example, billing Medicare for a highly sophisticated and expensive wheelchair, while only giving the patient a manual wheelchair is upcoding of items. Duplicating claims occur when a provider does not submit exactly the same bill, but alters small things such as the date in order to charge Medicare twice for the same service rendered. Therefore rather than a single claim being filed twice, the same service is billed two times in an attempt to receive payments from the government twice. Unbundling involves bills for particular services are submitted as fragmentary, which appear to be staggered out over time. Although, these services would normally cost less when bundled together, but by manipulating the claim, a higher charge is billed to Medicare resulting in a higher pay out to the party committing the healthcare fraud. Excessive services occur when Medicare is billed for something greater than what the level of

The passing of the Deficit Reduction Act of 2005 made an additional incentive possible for acute care hospitals who take part in the HCAHPS survey. Since July 2007, hospitals who are subject to the Inpatient Prospective Payment System (IPPS) annual payment update provisions need to collect and submit HCAHPS data if they want to collect their full IPPS annual payment. Inpatient Prospective Payment System hospitals that ignore to report the required quality measures, which includes the HCAHPS survey, could get an annual payment update that has a reduction of 2%. Hospitals like Critical Access Hospitals, can also participate in HCAHPS if they want to.

There is no standard Revenue Cycle billing process to ensure claims are accurately and compliantly billed to Medicare for inpatient stays of two days or less. Four of the 10 sample claims were non-compliant with the Two-Midnight Rule.

They already have an attendance management system we hope to integrate it with new system.

Using the tables from Task 1, design and implement suitable data entry forms which incorporate features to ensure the validity and integrity of data. You must include the following:

The biggest problem that I have had is trying to fix mistakes. But that is just a temporary problem. Another issue is keeping the various terms straight for the columns. Also remembering to change the payment if it isn’t accurate. I’m confident that after some more practice it will become easier. But these issues are basically because I’m new to all this.

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

Balance billing is when the physician was able to bill the patient for any additional balance that was left over after Medicare paid. In order, for this to happen the patient needed to pay the full co-payment the doctor wanted and then submit a form to Medicare to reimburse them the amount they would have paid. This increases the financial risk with a Medicare patient because most Medicare patients can’t afford to lay out the full price of the co-payment right then and their, so they don’t pay their doctor bills. By not paying their doctor bills, they are gaining more debt in their life. Also the patients that can lay out the money can forget to submit the form and don’t receive their reimbursement. By doctors using balance billing, it can

Medical field is one of the biggest fields. When I mention the word medical, the first thing come up to your mind are doctors or nurses. Some people that never work in a medical office, they don't know there are much more position in medical file you could work at, like medical assistant, technician medical coder or biller. Someone like me, don't like to deal with patient. Medical biller and coder is a good opportunity for me to work at. But what are medical biller and coder?

Over the years, there have been many projects and programs that have been implemented to address access to health care. However, there are still a significant percentage of people in this country that do not have a health care home. Nurse leaders now, more that ever are in a prime position to create and implement programs that allow access to the much needed health care. The purpose of this paper is to review the concepts of resource utilization and financial management in relation to creating a nursing program proposal to increase access to health care.