Health Care Case Study

Other patient information you may find is documentation for any allergies the patient may have. Insurance information will be noted if the patient is covered were you will find the provider, the billing address, and the patient’s policy number. There will be many different forms in this system that are used to document things such as the patient’s family history, diagnostic results, immunization records, past and present medications taken and the effectiveness of them, and of course there will be doctors notes for any office visits and hospitalizations. In the doctors notes and hospitalization notes you will find documentation for medical conditions or diseases the patient may have had in the past or has presently. Last but certainly not least there will be the common release and authorization forms, there may be advanced directives or living wills on file if the patient has completed them and other relevant information that staff and medical facilities may need to provide quality care for the patient. (Whatis.com, 2008).

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.

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

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.

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.

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

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

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.

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

The most important aspect of this form is that it provides quick turnaround for payment and pays for most anything a patient may need ("Form CMS 1500At A Glance," 2012).

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.

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.

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

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