Health Care Case Study

The information that should be obtained from the patient at the time of scheduling the appointment is the reason for the visit, name, DOB, phone number, and insurance information.

Patient Check-In and Check-Out - If this is the patient's first visit, forms are required to be filled out, a copy of photo I.D. and verification of insurance card is accessed.

NOTE: Effective April 1, 2014 Medical Assistance (MA) will only accept the revised CMS-1500 form (02-12) version

You are letting the provider know what the patient chief complaint or reasoning is to be seen at the office that day. All information the patient has prior will be beneficial for the process of the claim.

Although both forms differ they both contain elements in each form are very similar in many ways. When using the CMS-1500 form the elements guides you to add all of the demographic information needed on the patient, their medical procures, dates admitted into the hospital, total charges and information on the provider who rendered the medical services. Elements one

The E/M code's is a big important part in this process. Being a health care professional, using the medical code's. like medicare, medicaid, other private insurance to be reimbursement. If not using the right code, the doctor office, hospital, and urgent care. Will lose a lot of money. So using the right cpt code's insurance companies, office, hospital, and urgent care can be reimbursement correct. Cause CPT code's are formed with 5 digits.

The patient is informed about their coverage and the amount of copayment they would have to pay.

The first area outlined in the intake form is the client’s demographic information that included the client’s date of birth, social, insurance information, etc. necessary to process claims for reimbursement and the client’s provider information, such as primary care, and case management, to ensure fluidity for establishment of coordination of care between providers. The intake form

Patient fills out and signs new patient registration forms. Copies of I.D. and insurance cards are made.Create encounter form and new patient chart.

Answer the following patient information questions using the table provided. Refer to figure 4-10 on p. 83 of Health Information Technology and Management for assistance.

Patient presents to initial intake assessment with medical records (or medical record is received via mail prior to case conference):

Senate Bill 1216, 83rd Legislature, Regular Session (2013) amended Texas Insurance Code Title 8, Subtitle A, and added Chapter 1217 which requires the commissioner of insurance in Texas to prescribe by rule a single, standard form for requesting prior authorization of health care services (Texas Department of Insurance, 2014). Senate Bill 1216 also requires any health insurance issuers to accept and use the standardized form for all prior authorizations of health care services (Texas Department of Insurance, 2014). This plan also requires all parties to make the form available in paper and electronic form on their websites.

The item number 24E on the CMS-1500 claim form refers to diagnosis pointer or code linkage. This provides a link between diagnosis and treatment. The procedure I would use to teach Ruby the importance of locator 24E is to ask questions. The questions can be such as, ‘is there a clear and correct link between each diagnosis and procedure?’ or ‘is the documentation in the patient’s medical record adequate to support the reported services?’ (Vines-Allen et al.). By asking these questions to herself, Ruby can make a better judgment for code linkage and this will allow her to submit a clean claim. Submitting a clean claim is very important in reimbursement process as it allows quick reimbursement.

The forms that must be reviewed with a new patient in the state of South Carolina

A Certificate of Medical Necessity (CMN) form is a form that is required to help document other medical coverage such as medical equipment, prosthetics, orthotics and supplies. A Certificate of Medical Necessity requires the cost of the equipment, it should also include the type of durable medical equipment (DME), diagnosis or reason for DME, the length of time the equipment will be needed, start date or prescribing date and the provider name or signature. Sections A and C of the CMN form are completed by the supplier while sections B and D are completed the physician. The Centers for Medicare and Medicaid services (CMS) form number can be found at bottom of the page, CMN forms are referred to by their CMS number. A CMN form also has a DME