To whom may concern, I am returning the bill # --- for $81,305.97 for the following reasons: First, our health insurance company already paid several of the services Carle is billing us, which means that Carle is billing us for services that are already covered by our insurance company. As the table below shows, Carle’s billing does not include all the payments from HCC Medical Insurance to Carle Foundation Hospital. This omission signifies you are wrongly charging us $5,375.03 that we totally rejected. According To Carle´s Billing Paid for HCC Medical Insurance Description Service Charge Amount Payments Insurance Patient Balance Due Payments Insurance Patient Balance Due Double Billing Emergency $2,683.20 $0.00 $2,683.20 $2,146.56 $536.64 $2,146.56 …show more content…
Indeed, the documents provide the details of what services HCC has covered so far, the amount it has considered, the checks’ numbers, and their dates. Second, in the page 5/6 in the bill we have received from you, Carle Foundation Hospital suggests us to apply to the “Carle Financial Assistance” program. However, Carle Foundation Hospital already approved 100% of coverage under the program, as the letter we received from you in [date] states. Therefore, as the Carle Financial Assistance program has approved our application, we understand that the balance of $1,748.90 indicated in the table above should be covered by the CFA. So, we assume that your letter inviting us to apply to financial assistance is a mistake and not a bad joke. You can find attached the letters we have received from you showing you have approved our financial assistance between November 2016 and November …show more content…
Indeed, we repeatedly have informed to Carle Foundation (by phone, by letter, and personally in their offices) that HCC rejected covering my son’s accident because it wrongly labeled as a sports injury when it was not. We want to clearly insist that this was the reason the company rejected the medical coverage and not our supposedly lack of diligence on providing HCC all the required information, as Carle Foundation several times has stated in our communications. On the contrary, since the same day of my son’s accident, we called, uploaded, and mailed all the information we had to both HCC and Carle Foundation in order to facilitate all the process as smoothly as it could be under circumstances such a son’s injury. Believe us: More than anybody, we want that our health insurance company provides the coverage it must, as sooner as it could
Membership Services (MSD) at Kaiser Permanente used to be a modest department of sixty staff. However, over the past few years the department has doubled in size, creating minor departmental reorganization. In addition the increase of departmental staffing, several challenges became apparent. The changes included primary job function, as well as the introduction of new network system software which slowed down the processes of other departments. These departments included Claims (who pay the bills for service providers outside of the Kaiser Permanente network), and Patient Business Services (who send invoices to members for services received within Kaiser Permanente). Due to the unforeseen challenges created by the system upgrade, it was decided that MSD would process the calls for both of the affected departments. Unfortunately, this created a catastrophic event of MSD receiving numerous phone calls from upset members—who had received bills a year after the service had been provided. The average Monday call volume had risen from 1,800 to 2,600 calls per day. The average handling time for each phone call had risen as well—from an acceptable standard of 5.6 minutes to an unfavorable 7.2 minutes. The department continued to be kept inundated with these types of calls for the two years that these changes have been effect.
The first step is to pre-register the patient's insurance information into the computer system and making a copy of their insurance cards. The patient's insurance information would then be verified. The patient would then be seen by a medical professional to examine the patient, discuss any test results or provide a diagnosis. Once the patient is ready to check out any payment due would be collected. The medical coder would then go over the patients' medical record and assign any diagnosis codes or procedural codes and then a claim form (CMS 1500) would be completed and submitted. The payment would also receive and posted at this time and document in the patient's record. The CMS 1500 will information from the patient, including the type of
Another downfall to HMO coverage is selective-contracting. This is a process where hospitals deny treatment to patients because their...
As a Medical Biller and Coder, you will submit claims to third-party payers for reimbursement of services rendered. Try to set up your claim to be payer specific because you want the claim to be paid after the first submission. There are remittance advices sent to the Medical Biller and Coder from the third-party payer that help to inform you if the claim has been denied, paid, or pending. If your claim has been denied or pending than you can begin your investigation to figure out the reason(s) for the nonpayment of services rendered.
This letter went to explain our mission statement and our goal requesting their help in the building of our skatepark which is located in the local community. We were seeking any type of donation these larger companies would provide us with following this letter. Once we meet the towns basic criteria and with an architect stamped design in hand, we began the process of having the recreation board vote on approving our skatepark. The recreation board would then present it to the town board requesting their approval. At this point, all we would be waiting upon would be the funds. Unfortunately, the application process for grants were much more intense requiring all the criteria we used for the towns approval plus more. Once we have all the necessary documentations we must wait for the application date to submit our request. We then await the foundations and answers to begin out
Based on the documentation submitted, from 06/15/2017 through 07/04/2017 and 07/07/2017 through 08/28/2017, the claimant does not have functional impairments. As it relates to hypertension, fatigue, and hyponatremia, according to the provider, the physical findings were suggestive of a cerebrovascular disease affecting the left hemisphere which was a complication of her hypertension. However, there was insufficient objective evidence to substantiate a severe functional impairment during the period of review. Although she had an elevated blood pressure measurement (ranged from 152/90 to 190/110 mmHg), the report dated 07/19/2017 stated that she was feeling better overall. Her laboratory testing dated 08/04/2017 were within normal limits and the appropriate conservative options were provided (Amlodipine, Apresoline,Clonidine, Aspirin). As it relates to her hyperglycemia, the most recent laboratory testing revealed a glucose level of 88 (normal). As it relates to osteopenia, the Bone Density test only revealed mild bone thinning and according to the provider, her calcium level was just slightly elevated. As such, the claimant is not considered disabled from 06/15/2017 through 07/04/2017 and 07/07/2017 through 08/28/2017, strictly from the perspective of Internal
Many individuals have the opportunity to choice a healthcare organization for their healthcare needs, but cannot afford the costs. One in particular is the United Healthcare group which provides individuals with the most ideal care. Individuals are given the opportunity to make the best decisions for their health needs (UnitedHealth Group, 2015). These decisions have profoundly established, a life enhancing positive health outcomes. United Healthcare gets a handle on this position of trust and the essential social commitment they have to serve people 's medical needs in the United States and around the globe (UnitedHealth Group, 2015). The purpose of this paper is to discuss United Healthcare readiness in addressing the healthcare needs of
In order for any health care system to be stable in their revenue cycle, it has to post charges for procedures and care provided. If these charges are not posted correctly, the payments may be affected, resulting in less income than what the system is actually owed. Clearly, without any service being provided, there is no revenue to begin with, but if the charges are not captured, a service can be provided and not billed for (Cleverley & Cameron 2007). This means the health care system provided free care or services to a patient. In order to capture care charges, health care organizations use codes for each type of procedure provided. Because the health care industry is so complex, capturing said charges is also complex and most charges are broken down in order to prevent complex bills. The way charges are broken down is by using codes for the services rendered. Each procedure has a special code and each code is assigned a price, making billing less complicated. Coding also allows health care systems to document each procedure in order to prevent payment denials or delays from the payer (Thompson & Barrett 1993).
Analyzed account balances on patient accounts to determine if payments had been received and applied correctly based on the explanation of benefits that have been received from patients insurance.
Then, patients have the choice of paying at POS or paying later (Butcher, 2015). For uninsured patients, the estimation tool automatically raises the discount program. Baptist Health incorporates a 40 percent reduction from the full amount (Butcher, 2015). However, numerous patients cannot bear the high costs of health care services, even at a reduced rate. In this case, patients at Baptist Health are referred to a registrar who uses a four-question study to determine if a patient qualifies for Medicaid (Butcher, 2015). If a patient does not qualify for Medicaid and cannot bear the estimated costs, he or she is referred to a financial counselor to apply for charity care (Butcher,
Through a series of laws, Louisiana has established a Patient’s Compensation Fund (PCF) that automatically covers all state health care providers. The fund is designed to compensate patients who suffered loss, damages and expense because of professional malpractice by a health care provider who is a member of the fund. Private providers may join the Fund as long as they meet few requirements. The revenue is generated through surcharges paid by private healthcare providers, including hospitals, physicians, nursing homes, chiropractors, optometrists, dentist, oral surgeons and nurses. Damage caps in medical malpractice cases are based on joining the PCF. Recovery against a health care provider is limited to $100,000 per patient plus interest per patient per incident. Anything in access of this cap is placed in the patient care fund. A total recovery in medical malpractice cases is limited to $500,000 plus the cost of any future medical expenses. The PCF pays for any future medical expenses directly (Dekaris, Mims,
A health insurance broker is a licensed expert in their profession. A broker is someone who can help one find the best health insurance plan that’s fit for you and your family. Insurance brokers are free to recommend multiple different insurance companies. They are not tied down to just one. This allows them to better help their customers find the best match. Unlike the insurance agent who represents one or more insurance companies, a broker represents the buyer.
...0. CMS-1500 is the basic form that has been set by Center for Medicare and Medicaid services and is used by most outpatient clinics. CMS-1450 is the form that is used hospitals to claim reimbursement for hospital visits. While CMS-1500 is used for patients who are under Medicare Part B, CMS-1450 is used for patients insured under Medicare Part A. Some of the charges that need to be claimed using CMS 1500 are ambulatory surgery performed in a certified Ambulatory Surgery Center, all hospital based clinics, and hospital based primary care office. Furthermore, some of the charges that need to be claimed in CMS-1450 are emergency department visits, ancillary department visits, outpatients services such as infusion therapy or observation, all services rendered during an inpatient visit, and any pathology service provided regardless of patients’ presence (Ferenc, 2013).
Let’s briefly review the steps of the medical billing procedure leading up to the transmission of an insurance claim. When a patient receives services from a licensed provider, these services are recorded and assigned appropriate codes by the medical coder. ICD codes are used for diagnoses, while CPT codes are used for various treatments. The summary of services, communicated through these code sets, make
Submit your reimbursement claim in the Web office with all necessary documentation, make sure that you submit the correct receipt, or not submit the same receipt more than once.