1. Discuss the relationship between patient accounts, data flow, and charge capture. The relationship between patient accounts, data flow, and charge capture is the following the patient account data flow includes information regarding patient care services provided and supplies or items required to provide those services. Data flow in a hospital is designated to ensure that required data are accessible for personnel to perform various functions. For example, ultimately aids in the charge capture procedures which is the common term use to describe the process of gathering charge information and recording it on the patient's account. 2. List two reasons why the HIM Department reviews patient medical records. Patient’s medical record is forward to HIM after discharge for medical record review for various reasons, two of them being for the Coding of Clinical Data …show more content…
Why is the billing process important? Explain. The billing process is important because is crucial in maintaining the financial stability, the hospital must have an efficient process for obtaining reimbursement from patients and third-party payers. Alongside the billing process Accounts Receivable (A/R) Management is responsible for monitor outstanding accounts from patients the government, and other payers to ensure that payments are received in a timely manner. 4. State the difference between the CMS-1500 and UB-04 (CMS-1450)? The difference between the CMS-1500 and UB-04 (CMS-1450) is the following: The Health Insurance Claim Form (CMS-1500) is the form required when submitting Medicare claims and is accepted nearly by all state Medicaid programs and private third-party payers as well as by TRICARE and workers’ compensation. The Uniform Bill (CMS-1450 [UB-04]) claim form is used by institutional facilities (for example, acute care facilities, dialysis centers, inpatient skilled nursing facilities, or rehabilitation centers) to report fees related to professional and technical
On the basis of the clinic’s previous collections experience, Dough was able to convert billings for medical services into actual cash collections. On average, about 20% of the clinic’s patients pay immediately for services rendered. Third-party payers pay the remaining claims, with 20% of the payments made within 30 days and the 60% remainder (of total billings) paid within 60 days. For monthly budgeting purposes, 20% are assumed to be collected one month after the billing month, and 60% are assumed to be collected two months after the billing month.
Other Sutter Health-affiliated hospitals date back to the 1800’s and was some of Northern California’s earliest health care providers. In 1866, the predecessor of today’s Sutter Medical Center of Santa Rosa opened its doors to residents of Sonoma County. Today in the United States there are nearly 47 million Americans uninsured and 80 percent of that comes from working families. The article by Souza and McCarty, “From Bottom to Top: How One Provider Retooled its Collections,” covers how one of Northern California’s largestproviders, Sutter Health, approached implementing a new strategy to increase collections. In collecting payments from new patients, services provided, comes from the need to implement new strategies on how and when to collect the payments. Sutter Health have made a successful new program to implement and define most problems within their A/R department, developed solutions to their problems and have recognized the need to ensure the program is continuo...
As a certified medical coder (CCA 11/2012), I have contributed to the HIMS department by helping code inpatient encounters from patients in the Residential Rehab Unit as well as outpatient encounters from the other clinics at this VA applying the official coding conventions outlined in the International Classification of Diseases 9th revision handbook as well as in the VHA’s Official Coding Guidelines, V11.0 dated August 10, 2011. Having coded many encounters over the past 3 years, I can easily determine the main condition after study that is chiefly responsible for a patient’s admission to the hospital. ICD-9-CM defines this as the primary diagnosis code and I find that it is most important to list this code first in your documentation
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
According to what I read in the textbook, the CMS 1500 form is divided in two considerable parts: 1- Patient and Insured Information, which you can find in locators 1 through 13; and 2- Physician or Supplier Information, which you can find in locators 14 through 33. But this form can be divided in three sections as well: 1-Demography (from locators 1 through 13), 2- Procedural and diagnostic information (from locators 14 through 24) and 3- The technical part (from locators 25 through 33).
The biller normally gathers all data concerning the bill including claims transmission, payment posting, charge entry, insurance follow-up and patient follow-up.
There are several errors that can occur in the billing and the coding process. When there’s a problem in the coding process it can cause rejected claims. Some of these problems consist of truncated coding, mismatch between the gender or age of the patient and the selected code when the code involves selection for either criterion, assumption coding (reporting items or services that were not documented, but that the coder assumes were performed), altering documentation after services are reported, coding without proper documentation, reporting services that are produces produced by unlicensed and or unqualified clinical personnel, coding a unilateral service twice instead of choosing the bilateral code, and not satisfying the conditions of coverage for a particular service. These errors can result in denials or payments being delay...
Jethani,J. (2004). Medical records – its importance and the relevant law. Vision 2020, IV(1), Retrieved from http://laico.org/v2020resource/files/medical_records_Jan>mar04.pdf
Patient accounts are unique to each patient who is serviced by the facility. The account holds information such as the patient demographics, any insurance information, and patient’s medical records. Data flow is to make necessary information is accessible to necessary employees to complete treatment. Charge capture is how information is accumulated and put into a patient account. All three of these processes are valuable to patient care. Separately, these three components have processes within themselves, however, they come together to create a complete process that begins when the patient signs into the facility until the accounts receivable has been resolved.
“Our involvement in a Health Information Exchange (HIE) played an important role in helping us recover from this data loss…As a result of that effort, lab tests, diagnostic imaging results and transcribed reports like operative reports, discharge summaries and inpatient progress notes were available for use in re-creating the patient record.”
Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007). In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals ...
...nce an incident that may not be seen as such by staff working in the same environment but, if the staffs have frequently witness that the same incident occur; they may stop reporting the incident. However, database application system can save charting time which could be utilized to provide care to residents. Administration function like medical records, risk assessments, daily reports and coding requires documentations from the service users` electronic medical record database to enhance the EHR, which link the EHR data with databases containing standardized assessment information from external healthcare systems. If the database is not similar as to what other healthcare systems use, it is impossible to share information from EHR database with other clinical application systems.
...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).
A hospital billing process begins when an individual comes in for diagnosis and treatment for an injury and is admitted for more than 24hours. The admitting clerk first obtains a person’s demographic such as age, gender, address, symptoms, and insurance information which is entered into a computer system. Once everything is verified by insurance verifier, admitting clerk collects co-payment and assign a patient an account number, which is associated with all charges and payment related to the duties of care. Once a patient is admitted the attending physician dictates history, which includes admitting diagnosis. Then the nurse enters the patient’s medical records and inputs physician orders in a computer. After attending physician supply documentation
Accounts Payable is money owed by a business to its suppliers shown as a liability on a company’s balance sheet. It’s distinct from notes payable liabilities, which are debts created by formal legal instrument documents. The accounts payable is important to the company because it involves all of the company’s payments outside the office besides payroll. It’s the way the office handles all of the money owed. The accounts payable payments may be carried out by a department in a larger corporation, by the staff in a medium-sized office, and by a book keeper in a smaller office setting. The system is designed to record a sub-ledger at the time an invoice is vouched for payment. Vouchered or vouched is an invoice that’s approved for payment and is to