The Importance Of The Flow Of A Patients Information

In the medical field there have been a lot of technological advances and making health records electronic is one of them. The days of having a paper health record are almost obsolete. An electronic health record keeps a patient’s medical information and history on a computer which is accessible to more people in less time. I will explain how the continuity, communication, coordination and accountability of the electronic health record can help the medical office. I will explain what can be included in the electronic health record. As an advocate of the electronic health record I will also explain some disadvantages to the electronic system.

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

Some health institutions believe that all the patients have the powers to control the use of their records and before any file is accessed, the patient must be consulted by the personnel responsible. To others, however, some of the patients may not know the needs of the health industry, and therefore, at least 200 people can be allowed to access their records. According to this group, the only way to improve the patient’s privacy is by reducing the number of people who access the records. Thus, despite the fact that digital files save on cost and time, there is need to focus on some of the issues affecting the privacy of records in the health sector. Therefore, as much as the current law allows sharing of patient information during payments and treatment, caution must be taken to reduce data mining and marketing using the same

13). The clinical services department within the hospital is responsible for the accurate charting of any procedure or service that was provided to the patient. This process begins with patient registration and verification. The healthcare provider then will perform their job as necessary and will indicate what billable tasks were performed which can later be processed. The patient accounts department is responsible for going through the patient’s chart and recording the patient’s bill by use of the hospital’s chargemaster to send the bill to the payer by the health information department. In this department the initial coding of the patient’s medical record is done. Once overviewed for the sake of accuracy, the final coding is done and sent to the payer. Any inaccuracies by any of these departments could directly impact the hospitals reimbursement process through a slowing for the process or simply by failing to bill for a procedure performed, ultimately hurting the hospital’s financial stability. The patient financial services (PFS) department is responsible for ensuring compliance within the billing and coding policies through training and with quality assurance checks and regular audits. This ensures that the revenue and reimbursement cycle continues without any inaccuracies in patient charges. It is especially important to have quality management within this department, as it has the potential to affect the entire organization, reflective of the institutes financial situation. Poor PFS management can lead to a loss in revenue and can lead to a loss in budget if the hospital is losing too much as a result. Ensuring compliance with medical coding and billing guidelines and policies ensures a more accurate representation of the hospitals financial and budgetary situations, while

I agree with you UB-04 form is very much detailed when compared to CMS-1500 form. Maybe because the UB-04 form is used for inpatient care in which medical care is provided for more than 24 hours, therefore, there is a lot of information to report to process a claim. Whereas CMS-1500 form is used mostly for physicians offices which comprise of one short visit to the doctor. There are locators on the UB-04 form that reflect information about the hospital stay such as room and boarding, admission and discharge time, admitting and principal diagnosis, attending and operating provider and much more. On the other hand, CMS-1500 has locators that define one particular visit such as procedures done on that day, amount paid by the patient on that day

The potential sources of the problem that most of the healthcare institutions are experiencing could be that the healthcare organizations have not trained its staff or employees on how to do data entry as well as protection of the data that contains the information of the treatment cost as well as services. For that reason, the organizations should always train its staff on how to do data entry process and protect the data from being accessed by the unauthorized persons who could manipulate the data. The supervisors of the healthcare organizations are then supposed to be monitoring and also reviewing the process of entering data. That is to avoid the data inputted into the system being inaccurate. Another possible problem that they

Data then flows into two functions: (1) the medical documentation, which becomes the basis for clinical decision making and goes into the medical record; and (2) the charge capture or entry, where the manual “charge slips” or automated direct order entry are priced in accordance with the price list referred to as Charge Master, also called Charge Description Master (CDM). Thereafter, data from both Medical Record and Charge master flow right into the billing system. Then, claims preparation follows by filling up of either of the two types of forms: (1) UB-04, which is used by hospitals for inpatient and outpatient service claims, or (2) CMS-1500, which is used by Physicians for professional claims. These forms are then carefully reviewed in the claims editing process to ensure there is enough information to warrant payment by the payer, and logical standards are complete and well documented. (Claims Editing is not conducted by all health care facilities, but is a critical effort to secure accurate and timely payment by payers). Finally, the claims are submitted to the payers.

The key elements to a healthy and successful medical practice are a reliable and properly trained staff and a sound revenue cycle that produces satisfactory reimbursement. Revenue cycle management starts at the front-end with pre-registration of the patient. Complete and accurate recording of patient insurance and billing information is imperative. Insurance verification plays a major role in the assurance of reimbursement. The front desk should counsel and confirm financial responsibility with the patient during the registration process. Patient encounter is equally as important. Correct coding of patient diagnosis and procedures minimizes the likelihood of claim rejection. The next step in the revenue cycle is claim submission. The claims process begins with the provider treating the patient then sending a bill to the designated payer. Before the bill is sent, a certified coding specialist or medical billing specialist prepares and reviews the claim for any inaccuracies. There are a few ways the claim is submitted, either manually or electronically. Once the claim is submitted, follow-up with third party payers is a necessary step in the

A medical officer while taking data does them through billing in most of the occasions. The medical officer or the physician should use a universal billing form and also the global facility form on this occasion. The preferred form by the medics, in this case, is the AICPA and for the universal billing is from 1500. It is advantageous in that all patients can use it especially for the outpatient ones (Greene & Martel, 2012).

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).

There are many types of data collected, such as, Demographic, financial, socioeconomic, and clinical data are collected from patients so that the healthcare providers of services to the patient are able to assess the history of whatever disease the patients is suffering from and how is to be treated. Data collection in the facility is well organized in a way that promotes shared assessment, treatment and communication. Nurses and front row staffs collects raw data’s from the patient, and. The Heath Information Manager and team are the facility are responsible in analyzing and presenting the data collected in a meaning and easily understandable way to served the specific purposes for which it was collected. Examples of such data are, patient’s name, height, weight, gender, allergies, and third party

• Who Uses the Paper CMS-1500 Form? II. Documents Needed When Completing the CMS-1500 Claim Form A. Patient Information Form • New Patient Information • Insurance Section • Additional Insurance • Insurance Authorization and Assignment B. Patient Insurance Identification Number C. Patient Health Record D. Encounter Form III. Completing the CMS-1500 Form • Patient/Insured Section • Physician/Supplier Section IV. The Three Sections of the CMS 1500 to Fill • Parts 1-13 (Patient Information) • Parts 14-24 (Procedural and Diagnostic Information) • Parts

For my process report, I have chosen the topic of the CMS-1500 health insurance claim form. In the medical insurance field, the current popular form of billing is the use of the 837P (Professional) format, which transmits health care claims electronically.

The CMS-1500 form was developed by the center for medical and Medicaid service (CMS) to facilities the process of billing by easily arranging diagnoses and service providers that were necessary to treat the patient, the upper from consist in 13 form locators that contain 11data element. And the lower portion of the form consist of 20 form locator numbered 14 through 33, which contain 19 data elements, and one signature for locators.

This report puts forwards the justification for consolidating all the medical receipting and payments processing into the core medical system, to improve the efficiency of operations and eliminate most of the manual related processes in the current scenario. The Actisure Medical system already has the accounting functionalities within itself, thus it will be beneficial to utilize these functions and eventually improve