Working At Partnership Health Center, Billing Office Essay

Assignment: Keeping People Safe Unit 7: Principles of Safe Practice in Health and Social Care A: Examine how duty of care contributes to safe practice in health and social care settings B: Understand how to recognise and respond to concerns about abuse and neglect C: Investigate the influence of health and safety legislation and policies in health and social care settings D: Explore procedures and responsibilities to maintain health and safety and respond to accidents and emergencies in health and social care settings Task 1: Evaluate significance of duty of care, explaining its significance in promoting safe practice, Evaluate significance of complaints procedure in promoting safe practice, and justifies the procedures used when responding

Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can leads to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.

The value of CDI clinical documentation improvement (CDI) programs are important to any facility that recognizes the requirement of complete and accurate patient documentation. Documentation is very critical because it validates the care that was given. Furthermore, it shares important data to the caregiver and improve claims processing (Leventhal,2014). The three challenges are getting physicians to buy into the program, physicians are extremely busy so they are not connecting the dots on clinical documentation, and training the physicians to get them to understand they need to do better documenting (Leventhal,2014).

The U.S. Department of Health and Human Services (HHS) is the U.S. government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. HHS is responsible for almost a quarter of all federal outlays and administers more grant dollars than all other federal agencies combined. The mission of the U.S. Department of Health and Human Services (HHS) is to enhance the health and well-being of Americans by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services. In addition, HHS is also responsible to provide better services to people by adapting to new technologies to keep pace with the advancement in technology. As we compare the health and human services from last ten years to present, it is very clear to analyze how health and human systems have improved over the years. The Department manages programs that cover a vast spectrum of activities that impact health, public health, and human services outcomes throughout the life span.

My field placement is at Highland Clarksburg Hospital. I work with an amazing woman named Amy, she is a case manager on the children’s unit. The basics of my field placement was to help providing quality behavioral health care services to children, adolescents, and adults in a caring environment (https://highlandhospitalwv.com/our-promise/). Highland Clarksburg Hospital is acute care hospital. So the patience can be there for a little bit depending on their insurance. Why the hospital is there is because there aren’t that many hospitals around to help children in need of behavioral health. History of Highland-Clarksburg Hospital dates back to February 1, 2010 when Clarksburg’s City Hall announcement was made UHC would donate the facility. The United Hospital Center built a new facility. They opened of the Children and Adolescent Unit in August 2013 and the reminder in January 1, 2014.

When claims are filed documentation must compare to the amount of service provided. The rule is, “if documentation of procedure is not written, it did not happen. Evaluation and Management (E & M) guidelines are checked periodically to ensure medicare and other payers follow guidelines. The E & M informed and update rules and regulations for coding to ensure practices maintain compliance. Physicians has the responsibility of ensuring employees are trained to coding standards and should periodically go over records themselves to make sure all guidelines are followed.

In this case, a small non-profit healthcare clinic that has been in business for the last ten years providing voluntary services is currently facing several issues that are affecting the organization. The clinic started as a comprehensive community effort, with a large group of healthcare providers as volunteers that were concerned about the health of people with low-income in the that didn’t have access to basic health care. This resulted in a new non-profit organization with the founders serving as the board of directors. During the first years when the clinic was getting the business off the ground, their mission was to serve all comers and not to turn anyone away, regardless of their financial situation (Buchbinder, p. 441).

Before we file a medical claim, there are multiple steps that a medical office specialist must complete first.

The steps that Lewis should take to verify Sylvia Baker insurance would be to first take down there name, date of birth, name of the primary person, social security, information of the insurance provider such as name and contact. As well as the patient insurance group number and ID. second thing that she would do is ask for a photo ID as well as the patient insurance card to make a copy to keep in there files. third would be to call the patient provider and make sure that there vist is being covered. Forth would be for Lewis to make sure that the patient does or does not have a copay as well as if they are in or out of network. Lastly Lewis should ask the patient if they have a secondary insurance that they would like to put on file and if

In preparing insurance claims and patient statements for submission to third-party payers, follow-up staff further process the claim through a program called claim scrubber which performs a series of checks to assure accuracy of (a) data, (b) fields that are required to be filled, and (c) valid codes (Agency for Healthcare Research and Quality, 2014). After the scrubber process, follow-up staff then submit either an electronic media claim (EMC) or a manual claim printed on paper and mailed. Additionally, follow-up staff may

The life cycle of a claim form begins when a patient calls a physician’s office and requests an appointment. The administrative staff member must determine if the patient is new or established, and the reason for the visit. Establishing financial responsibility is the next step in the claims process. Verification of the patient’s insurance information, if any, should be done prior to scheduling the patient for an appointment. Once the appointment is scheduled and the patient arrives to the office, the patient is checked-in. This step is known as registration. Any missing or incorrect information is updated at this point. Co-pay is collected, if required. In addition, if the patient is new, authorization forms or other administration forms

The CDI specialists are one of the many professionals whose roles are to review clinical documentations and provide feedbacks to healthcare providers such as the Physicians. The feedbacks are intended to fill the gaps in the documentation that addresses issues with quality measures, coding and the general care of the patients. The need for achieving a successful clinical documentation is driving many healthcare organizations to adopt a CDI initiative toward the goal of improving patients’ quality of care and

Proper documentation is the best defense against a malpractice claim, Dr. Jeff Greenberg writes in a commentary for UCLA's Department of Medicine. For judges and juries, if a procedure doesn't appear on a chart, it hasn't been done. Physicians must ensure that all X-rays and other lab work are done, and follow up with the patient. This step minimizes the risk of a missed diagnosis. Good record keeping is also vital in dealing with patients who are abusive, don't follow advice, or present the same complaint without improvement.

Case management in the emergency department, constantly works to find the right data in a patient’s record to ensure that they have the correct insurance coverage and can be admitted or discharged at the appropriate time and place. Even when the smallest amount of essential information is not documented, this otherwise straight forward process turns into a scavenger hunt for who has seen the patient, interventions that were done and for what reasons, and at what time all of these things took place. ED case manager Veronica Kountz (personal communication, March 20, 2015) states that the inadequacy of documentation can lead to insurance companies not covering patient costs, which the hospital then has to absorb. Before a patient can be admitted or discharged, the right

Mr. Paul Couturier, the CEO of Health Development Corporation (HDC), was negotiating the sale of his company in the spring of 2000. The Company, which owned and managed health clubs in the Greater Boston area, had retained a local investment firm, Kaufman & Co., to solicit bids. They received several bids from national or regional health club companies seeking to establish themselves in the Boston area. The bids were lower than expected, largely because of the way the bidding companies considered HDC’s ownership of Lexington Club’s real estate. Like most health clubs, HDC generally leased their health club real estate but in 1999, HDC had taken