Sample Case Study Post-Dated Check

SC received a call from Pa and completing monitoring telephone call. Pa reported that she is having difficulty securing transportation to her medical appointments because her doctor did not complete the necessary paperwork the insurance company needs to continue to provide door to door pick up. Pa reported that she missed three important appts with her Nephrologist, pulmonologist and rehab for lungs. Pa reported that her lungs are really bad and she was offered lung therapy because she is experiencing SOB more and more so she is unable to help completing her ADLs and IADLs. Pa reported medication changes she now takes Benzonatate 200 mg to help with severe coughing and Prednisone. Pa confirmed that she is receiving her services as specified

Dennis Seeds (October 31, 2014). How oversight and a little skepticism can help curb fraud in the workplace. Retrieved from http://www.sbnonline.com/article/how-oversight-and-a-little-skepticism-can-help-curb-fraud-in-the-workplace/

Pt. failed to attend his scheduled counseling session on Monday, 12/12/16 at 7:00 am Patient showed up after dosing (8:24 am) reporting that he was unable to keep his appointment for today because he got an emergency. Pt. reported that he cant stay because he needs to go to work but he rescheduled his counseling session with this writer for Wednesday, 12/14/16 at 7:00

In January of 2000, Any Kind Checks cashed two checks written by John Talcott, Jr. The first was for $10,000. After Federal Expressing it, Talcott spoke to Rivera (his “financial advisor”) on the phone, who indicated it was more than he needed, so Talcott stopped payment on the check. Nevertheless, later that day Guarino (supposedly a broker working with Rivera) cashed the check at Any Kind, offering the Fed Ex envelope as proof the check was good.

SC received phone call from Pa’s DCW on 1/19/2016 stating that she has completed all PAS agency requirement and is now employed by the agency and her official start date will be on 1/21/16 after the agency nurse comes out and assess the Pa. SC congratulated the DCW and informed her of the hours she will be paid for. SC also, reviewed Pa’s care plan. SC asked if the DCW worker had any questions and she stated not at this time. SC informed the DCW that even though she lives with the Pa and also provided her with informal support if Pa wants to make any changes to her care plan she has to call SC her or have her director of care contact the SC or SCS. The DCW agrees and SC ends call. 3:05-3:13 PM.

2:27-2:55 PM SC called and spoke with to Pa’s dtr/DOC (Regina) who reported that Pa is doing well. SC asked if Pa had any recent falls and she informed SC Pa has not. SC asked if Pa has been in the hospital and she informed the SC that she has not. The SC provided information on Self Directed PAS. Regina informed SC that she is stratified with Agency Models PAS. The SC confirmed that there is no duplication of services and Waiver is the payer of last resort. Regina reported that Pa’s is receiving the correct amount of support necessary to ensure health and safety. The DOC confirms Pa’s is receiving the type, scope, amount, duration and frequency of Agency Model PAS from Guardian Angels Nursing Care. It was confirmed that she is getting

Lewis should start by calling the provider services number for Blue Cross Blue Shield to verify that Sylvia Baker is still currently insured through them. Once he has verified that Sylvia is in fact insured then he should ask them what coverage Sylvia has. Verifying insurance and verifying coverage are completely different but people tend to make the mistake that they are the same. Or sometimes they verify that their patient has insurance through the company they are calling but don’t find out what coverage they have, leaving the patient with a bill. I read that each state is different with how the CMS-1500 is supposed to be completed so Lewis also needs to check the provider manual for that state’s Blue Cross Blue Shield plans for guidelines.Mark’s

I review the patient account and she only will be receive from her BTL $205.00 as a valid credit b/c the patient account show a pending balance of $155.00 and we need to cover that balance before I send the refund request to our account payable department. Please advise the patient about her pending balance and the amount fee that she will be receiving.The refund process take like 2 weeks for the final

Thank you Nichole, I know that you have put in a lot of work on this. I had a conversation with Cigna HealthSpring yesterday evening. They had two requests to finalize the project, 1) add the claim numbers to the spreadsheet and 2) to provide the dollar amount of what is owed per the contract vs. billed charges, which are on the current and subsequent spreadsheet. This request is in line with your second bullet point; the contractual adjustments that we make on the accounts, because the charges on the bill are more than the expected payment.

Advise the Seller, upon checking our internal tools, I've found out that shipment was in Checked-In display shipments in the fulfillment center has reported as delivered. Checked-in inventory hasn't yet been through the receiving process. It shows here that her shipment arrived at the fulfillment center on Oct. 03 then they start Oct. 3 & 4 for the Checked-in process. Once, they have done the process it will automatically be updated in your inventory.

It is a vital step in the practice’s revenue cycle to follow up on submitted claims. The follow-up process should be initiated 7 to 10 days after the submission of a claim. This gives the payer a window of time in which to have begun processing the medical claim. Initiate the contact with the insurance carrier. Be certain to have all the necessary information at hand for the contact so as to use their time and your own as effectively as possible. This information would include, but not be limited to the federal Tax ID number, NPI (National Provider Identifier number), the name, date of birth and policy number of the insured, and the date(s) of service. Do not neglect to get information to identify who you are talking to, and

I have always found processing checks daunting. The process can be prolonged and requires patience. Many factors decide whether a check can be cashed or deposited. As the representative processing the check, it is my responsibility to verify for proper endorsements, sufficient funds and correct dates. It has become increasingly difficult to cash floating checks before funds are transferred to a customer’s checking account.

Imagine if the Bible had fine print. The teeny, tiny, fine print at the bottom of a contract or advertisement that makes stomachs turn, as the search for a magnifying glass begins. Andy Rooney once said, “Nothing in fine print is ever good news.” What if certain Bible verses had a small asterisk, which would point to exclusions at the bottom of the page? Some fine print examples might be: “1) Some exclusions may apply, 2) must not have sinned within the last 24 hours, 3) children not included, 4) offer not good after…, 5) void where prohibited or 6) quantities are limited.” What would it be like to read the fine print along with Bible verses? Scrutinizing and evaluating each verse. Verification would need to occur if this verse was applicable

With no dependents to claim, a city employee has $469.40 of coverage paid for by the city. The premium for an employee to insure a spouse is $938.80 under the Association of Washington Cities (AWC). The senior interviewed stated she had tapped into her Social Security through Medicare under Part B and Part D. The first calls for an approximate payment of $93 from Social Security to Medicare in order to cover procedures concerning health. The second plan covers any medications she needs. An example of a procedure was her latest CAT scan; the total costs amounted to just over $5,000. Medicare paid for 96.6% of the bill. The remainder was paid by Medigap, a plan covered by her premium (Cleland).

It appears that the patient is not planning to remain at this clinic for long term as she planning to go residential out-of-state, but no date or location has been