What Is 3.8 Ic Billing

Acutes on the ward. Nurse Ratched has had benefits from this control in the form of awards

With an audit by the Joint Commission (JC) in the near future, Nightingale Community Hospital (NCH) is performing a tracer patient survey to measure our compliance and identify issues that are in need of remediation. The practice of this type of survey tracks a patient’s care for the duration of their stay starting from the admission process and ending when they are discharged. This system allows us to assess our strengths and weaknesses concerning policy, procedures, and systems in place to provide quality care in conjunction with the standards set forth by the JC.

The RUC will be able to provide treatment to patients suffering from non-life threatening conditions and the most common illness, including pneumonia and flu, fevers, upper respiratory infections, sprains and strains, lacerations, contusion, and also necessary screening test, such as High Blood Pressure, mammogram, diabetes. Since the late 1980s and early 1990s, hospitals have looked to facilities such as RUCs as a means to reduce rate of inappropriate ED utilizations by triaging patients to less acute settings. The ED is not the most appropriate care setting for many patients, such as elderly patients and young children. Non-urgent patients account for well over 10 percent of the average ED’s caseload, and semi-urgent cases account for another

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

If patients were truly offloaded to NP’s by the triage system it would be cost effective based upon the service rate. But this did not happen. In fact, the percent of patients seen by NPs decreased from 40% to 28%, and the percent patients seen by MDs increased from 41% to 48% (excluding patients that requested a particular provider).

During the second week, I had the opportunity to accompany Mr. Price to meetings that he had with the managers of the nurses and schedulers. During those meetings, the managers discussed the ideal approach of how to accommodate patients who call the schedulers to acquire appointments for urgent medical concerns. There seemed to be a problem with patients taking up appointment slots when they do not have a true need to be assessed by their doctor. It was ultimately concluded that the schedulers would coordinate communication between the patient and the registered nurse. The nurse would then triage the patient’s concerns over the phone and provide medical guidance,

If a patient or carer wants to complain I would see if I could deal with it personally. If I was unable to resolve the issue, I would advise them to call or email PALS the hospital complaints department.

According to the survey, our patients didn’t enjoy their experience before their appointment. 73% of patients said that the receptionist did not greet them immediately. I know this was the case when I walked in for my meeting. The receptionist was on her phone texting instead of being aware of patients that could potentially be walking into the facility. Although the receptionist doesn’t greet them right away, 67% of people agree she was respectful and courteous. However, the biggest issue lies with patients not understanding the co-pay and possibility of additional costs. This is a problem that can be fixed easily, we just need to retrain our receptionists to greet each patient with a warm smile, and how to fully explain the costs that patients are required to pay. The receptionist play an important role in customer service, therefore they must be at the top of their game at all times. In order to fix the overall patient experience at our urgent care facility, I think we need to send out more surveys and bring back the follow-up calls. The follow up calls are important because patients will be able to express any concerns they had with their visit and we would be able to

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

The additional revenues that were collected due to increase in ICU capacity by 20 beds enhanced the total ED revenues by 10%.4 The efficiency of care delivery is decreased when patients are diverted to other hospitals, they have to wait for long period to receive care or if they are placed on the floors where they do not belong. This is seen often due to delay in discharging patients.3 These delays and inefficiencies are the primary cause of decreased satisfaction among patients, their families, hospital employees, and physicians. They also result in avoidable increases in patient length-of-stay, reduced quality of care, and lost or diminished hospital revenue.3

In society today patient encounters take place in a variety of different settings. Evaluation and Management codes (E/M) describe a patient encounter with a physician and are the most frequently used codes that adhere to unique criteria. The criteria are to identify the settings, patient type and level of service. In the CPT Manual E/M codes are located in the front of the book and are broken down by divisions which are known as categories and subcategories. The categories are the first level of division because they identify the location of where the service took place such as a hospital visit, office visit and consultation. The subcategories identify the type of service rendered depending on the patient type if they are new or established, age and frequency. Also the subcategories are classified into levels of services that are identified by specific codes. It is by utilizing this classification that one is able to determine the nature of the work by the service type as well as place and patient status.

I am very dissatisfied by the bills I got from the hospital regarding my visit to the ER. I would like to have a rationale from the Hospital as to the reason why I should spend a total of $1,727.8 for one unhelpful visit.

Coders must ensure the accuracy of the claims they submit by using valid diagnosis and procedure codes. Also with the roll out of ICD-10 they should be using the highest level of specificity (Fortney, 2014). Claims must be submitted using the current approved CMS-1500 (02-12) form with uppercase letters. The insured name must be listed in addition to the patient’s name if not the same. The patient’s name must be listed by last name, first name, followed by middle initial, commas can be used, but no periods. Additionally, the patient’s name must be entered as it appears on their insurance card. The address should be entered on three lines without the use of punctuation. Birth dates are required to be in an eight digit format. If information is not applicable it should be left blank and n/a should never be entered in the field. If a provider fails to enter the insured information correctly or omits information it could result in a rejected claim. If it is necessary for a provider to request pre-authorization for services or supplies that authorization number should be entered on line 35 field 23 (CMS, 2012). There are occasions where a payer may request supporting documentation to back up charges that have been submitted. The provider must ensure each page of supporting documentation has patient identifier information in the event it becomes separated

Entering the hospital charges is only one of my many job duties. Please use the printout that includes the admission date. If no additional diagnosis is written beside the “problem” catergory, I will bill only the diagnosis

Several existing problems precipitated the creation of the triage system implemented by Kathryn Angell in an effort to deliver improved medical care. The main problem was a lack of coordination in service delivery. This lack of coordination caused excessive wait times on the order of anywhere from 23 to 40 minutes to see a nurse, 40 to 50 minutes to see a doctor, and as long as 55 minutes to get a prescription filled. The practice of all nurses being involved initially in seeing all patients caused duplication of efforts, including repeating questions and examinations, and resulted in procedural bottlenecks. Additionally, there were inconsistent levels of service and extreme variation in treatment because of the different experience