After following the directions given for this assignment, I went to the website and signed up for e-mail updates of my choice. One of my choices was the ICD 10 updates and changes. In my future career, I hope to obtain, this would help, as I would like to get into the billing part of an office. Another career option I would love to be given the chance at, is working for the Office for the Aging. So, I also signed up for Medicare demonstrations. While signing up, I found an option that could help me now in my career, Medicare D plan information and changes. In the medical office billing department, they must properly code claims. If not, this can result in possible insurance fraud, loss of income for the medical practice, or even over charging the patient. These can negatively impact business in a medical practice. Most don’t realize that medical …show more content…
There are millions of insurance plans. With Medicare D, no one’s plan is the same. They all have different tiers, copays, deductibles, etc. Medicare and Medicaid are for individuals plan holders. Each spouse has their own card with a different ID number. This will be a great tool to help stay up to date on important Medicare D information, so I can pass this to my coworkers and we can help our patients better. The most important goal I set for myself is to provide quality care to each person I encounter. I do get that most places are about numbers, but the way you keep your numbers up and increase them, is by word of mouth. If you provide the best possible service you can to a patient, they will tell their friends. I have been working in retail pharmacy since 2008. I took a year off after I had my son. I just recently changed companies and my patients that found out where I am, have transferred their prescriptions. Over the last year at my new job, I have worked hard to earn the trust and respect from new
Claims sent to the insurance companies could be rejected or denied. A health care facility is there to help people with their health, but they are a business that needs income to stay in business. If a medical facility or physician files a claim that is incorrect the Center for Medicare and Medicaid Services may get involved, this could mean audits, fines, or worse. Medical coding and billing are very precise and detailed work where mistakes can cause serious problems.
Medical billing transforms health care services into billing claims. The responsibility of the biller is to follow that claim to ensure the physicians, hospitals, third party billing companies, as well as federal and state governments receive reimbursement for the work that is provided. An experienced biller can boost revenue performance for the facility while keeping the business running smoothly.
The amount of money that is spent on healthcare is a quite a bit of money but about 10% of all the money is a result of some sort of medical fraud or abuse. This is about 120 billion dollars. With HIPAA (Health Insurance Portability and Accountability Act) medical fraud and abuse can be tracked easier. HIPAA was enacted in august of 1996; this was to help improve the portability and continuity of the health insurance.
Healthcare professionals associated with medical billing and coding know the progress the technology has made so far. In the last few decades, medical billing and coding has switched from being a paper-based system to a computerized format. Under HIPAA laws, medical practitioners had to develop new software in order to send out electronic bills. With the advent of electronic medical records (EMR), with one touch of a button, doctors, Nurse Practitioners and PAs can gain access to all the care a patient has ever received from every healthcare facility the patients visited previously and can figure out possible illnesses. This enables statistical documentation of the population as a whole as well. EMR can also make the healthcare system more transparent and allow integration with reimbursement data. As the healthcare system changes, this will prevent unnecessary costs and make it easier to get the reimbursements needed to treat a patient.
I had the opportunity to meet with Dee Laguerra for a few hours and learned so much about the Medical records side of our facility and its impact on healthcare organization. As Director of Health Information Management (HIM) she is responsible for many aspects of managing the medical record; which is a legal document. I did not realize how complex this department is and how vital this department is to the legal and financial position of the organization. Dee’s position as director is the responsibility for the collection, organizing, scanning, and completions of the medical records in a timely matter after the patient is discharged. The reason for the timeliness of scanning the medical records is for the preparation for the coders to review all the charts to code for insurance billing. The time requirement for th...
Medicare was designed as a universal healthcare program for individuals 65 years old and older. This program is funded by Medicare taxes and general federal funding withholding taxes. Medicare is a partnership between federal and state with the goal to provide medical insurance to the elderly that is poor and disabled. Generally all people who are 65 years or older and qualify for social security will automatically qualify for Medicare.
There are several issues concerning the uninsured and underinsured patient population in America. There are many areas of concern the congressional efforts to increase the availability of health insurance, the public image of the insurance industry illustrated by the movie "John Q", the lack of good management tools, and creating health insurance coverage for all low income Americans. Since the number of uninsured Americans has risen to 43 million from 37 million in the flourishing 1990s and could shoot up even more severely if the economy continues to decrease and health care premiums keep increasing (Insurance No Simple Fix, 2001).
Professionalism can be defined as the competence of skills and principles of an individual in a profession. A professional must be knowledgeable in their profession, committed to improvement of one’s knowledge and skills, service oriented, covenantal relationships to patients/patrons, creative, innovative, ethical, accountable and a leader. These competencies are essential for a professional to perform and excel in their profession.
The two major components of Medicare, the Hospital Insurance Program (Part A of Medicare) and the supplementary Medical Insurance program (Part B) may be exhausted by the year 2025, another sad fact of the Medicare situation at hand (“Medicare’s Future”). The burden brought about by the unfair dealings of HMO’s is having an adverse affect on the Medicare system. With the incredibly large burden brought about by the large amount of patients that Medicare is handed, it is becoming increasingly difficult to fund the system in the way that is necessary for it to function effectively. Most elderly people over the age of 65 are eligible for Medicare, but for a quite disturbing reason they are not able to reap the benefits of the taxes they have paid. Medicare is a national health plan covering 40 mi...
“Medicare and the New Health Care Law — What it Means for You.” (2010). Medicare Publications, http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf
I suspect that the codes that the physicians are submitting for payment are not accurate. Entering inaccurate codes that will yield the highest revenue for the clinic is called “upcoding”.
Healthcare administration provides leadership and managemnt to health care systems, hospitals, and private or public health systems. There are requirements for most professions in the health industry but with the proper education and certification, most entry-level careers are attainable. Healthcare administrators are leaders so one must be able to handle the responsibility of the job. There are characteristics that can be associated with being a health care administrator. I have learned over the course of the past few weeks that this the career path that I would like to follow and have set a few goals to help promote my career growth. My research has helped me learn many aspects of this profession and what it takes
...ue to numerous medical errors. With the amount of medical errors that currently do occur which is a current health care issue it cost the health care billions of dollar each year to fix the mistakes that were made.
States in the recent years. The purpose of today’s health care is to manage costs while
Health care has always been an interesting topic all over the world. Voltaire once said, “The art of medicine consists of amusing the patient while nature cures the disease.” It may seem like health care that nothing gets accomplished in different health care systems, but ultimately many trying to cures diseases and improve health care systems.