1. Summary of ten steps of the billing processes and procedures. (explain each process)
In addition include:
a. Content and use of Registration or Encounter Forms,
b. Explanation of Benefits (EOB), and Remittance Advice (RA),
c. Advance Beneficiary Notice (ABN),
d. Participation Contracts,
e. The adjudication process for payers and providers.
A. Pre-registering patients: The main function of the first step is to schedule and update appointments as well as gather personal and insurance information about new and existing patients. New patients provide personal and insurance information to the scheduler, and pre-existing patients update any personal or insurance information with the practice that has changed.
B. Establishing financial responsibility: The second step is viewed as the most important because it determines what services will and will not be covered by medical insurance. It also determines if the patient or the insurance company is responsible for the payment of services. In a lot of cases, payment plans will be offered to patients with high out-of-pocket self-pays, like specialized procedures that insurance will not cover. Even if medical insurance is used, a copayment is generally required by the patient. Many physicians participate in more than one insurance contract, which are judged by the financial arrangements that are offered by the plan. Managed care systems are the most popular with physicians.
C. Check in patients: In this step, new and returning patient information is verified, outstanding balances are reviewed, insurance information is taken and placed in the patient’s file, necessary paperwork such as privacy and release of information statements are signed by the patient, and out-of-pocket expenses...
... middle of paper ...
...
Department of Health and Human Services, Health Care Financing Administration. (2000). Program memorandum intermediaries/carriers (Transmittal AB-00-116). Retrieved from http://www.aarc.org/members_area/advocacy/federal/AB00116.pdf
Anonymous. (2007). Mpro: michigan's quality improvement organization. Retrieved from http://www.mpro.org/
Anonymous, . (2011). American college of radiology. Retrieved from http://www.acr.org/Hidden/Economics/FeaturedCategories/Coverage/cac/lcd.aspx
Anonymous. (2011, May 31). Hipaa privacy rule accounting of disclosures under the health information technology for economic and clinical health act. Retrieved from http://www.federalregister.gov/articles/2011/05/31/2011-13297/hipaa-privacy-rule-accounting-of-disclosures-under-the-health-information-technology-for-economic#p-3 http://www.openclinical.org/medicalterminologies.html
Phase I addressed basic statutory definitions, general prohibitions, and explanations of what constitutes a financial relationship between a physician and a health care entities providing DHS’. Phase II deals with the regulatory exceptions, reporting requirements, and public comments pertaining to Phase I. Finally, Phase III Final Regulations were published in September of 2007, and largely addressed comments made after publication of the Phase II rules and regulations. It also reduced some of the regulations placed upon the healthcare industry by explaining and modifying some of the exceptions related to financial relationships between physicians and DHS entities where there is minimal risk of abuse to the patient, Medicare or Medicaid.
Sobel, R. (2007). The HIPAA Paradox. The Privacy Rule that’s Not. Hasting Center Report, 37(4), 40-50.
Introduction The Health Insurance Portability and Accountability Act of 1996, or HIPAA, is a law designed “to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes. ”1 HIPAA mandates that covered entities must employ technological means to ensure the privacy of sensitive information. This white paper intends to study the requirements put forth by HIPAA by examining what is technically necessary for them to be implemented, the technological feasibility of this, and what commercial, off-the-shelf systems are currently available to implement these requirements. HIPAA Overview On July 21, 1996, Bill Clinton signed HIPAA into law.
... Health Information Privacy For Consumers. Retrieved April 22, 2009, from U. S. Department of Health and Human Services: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
US Congress created the HIPAA bill in 1996 because of public concern about how their private information was being used. It is the Health Insurance Portability and Accountability Act, which Congress created to protect confidentiality, privacy and security of patient information. It was also for health care documents to be passed electronically. HIPAA is a privacy rule, which gives patients control over their health information. Patients have to give permission any health care provider can disclose any information placed in the individual’s medical records. It helps limit protected health information (PHI) to minimize the chance of inappropriate disclosure. It establishes national-level standards that healthcare providers must comply with and strictly investigates compliance related issues while holding violators to civil or criminal penalties if they violate the privacy of a person’s PHI. HIPAA also has boundaries for using and disclosing health records by covered entities; a healthcare provider, health plan, and health care clearinghouse. It also supports the cause of disclosing PHI without a person’s consent for individual healthcare needs, public benefit and national interests. The portability part of HIPAA guarantees patient’s health insurance to employees after losing a job, making sure health insurance providers can’t discriminate against people because of health status or pre-existing condition, and keeps their files safe while being sent electronically. The Privacy Rule protects individual’s health information and requires medical providers to get consent for the release of any medical information and explain how private health records are protected. It also allows patients to receive their medical records from any...
In December 2011, Texas Health and Human Services Commission (HHSC) received federal approval of a Medicaid Section 1115(a) Demonstration Waiver, entitled “Texas Healthcare Transformation and Quality Improvement Program,” for the period starting with December 12, 2011 through September 20, 2016. The main objective of the 1115 Waiver is to improve access to and quality of health care by expanding Medicaid managed care programs and promoting health care delivery system reforms while containing cost growth. Specifically, the Waiver created two new pools of funding—Uncompensated Care (UC) and Delivery System Redesign and Innovation Payment (DSRIP) pools—by redirecting funds that were available under the old Upper Payment Limit (UPL) payment methodology. DSRIP funding is used to offer financial incentives to health care providers that develop and implement projects aimed at improving how care is delivered to low-income populations. Specifically, the providers (often referred to as the “performing providers” or “performers”) propose and execute projects like programs, strategies, and investments designed to enhance access to health care, quality of health care, cost-effectiveness of services, and health of the patients and families served.
Health Information Technology for Economic and Clinical Health Act consists of several subtitles. The subtitle D of the Health Information Technology for Economic and Clinical Health Act deals with the privacy and security issues that are associated with the electronic transmission of health information. The Health Information Technology for Economic and Clinical Health Act requires that as of 2011 all healthcare providers are going to be presented with the opportunity of financial incentives for showing meaningful use of electronic health records (EHRs). The proposed incentives will be offered up until 2015 and after that, penalties may occur for the failure of representing the use of EHR. The Health Information Technology for Economic and Clinical Health Act even started grants for the training centers for all staff members that are required to support a health information technology infrastructure. (www.healthcareitnews.com).
The Health Insurance Portability and Accountability Act, most commonly known by its initials HIPAA, was enacted by Congress then signed by President Bill Clinton on August 21, 1996. This act was put into place in order to regulate the privacy of patient health information, and as an effort to lower the cost of health care, shape the many pieces of our complicated healthcare system. This act also protects individuals from losing their health insurance if they lose their employment or choose to switch employers. . Before HIPAA there was no standard or consistency for the enforcement of the privacy for patients and the rules and regulations varied by state and organizations. HIPAA virtually affects everybody within the healthcare field including but not limited to patients, providers, payers and intermediaries. Although there are many parts of the HIPAA act, for the purposes of this paper we are going to focus on the two main sections and the four objectives of HIPAA, a which are to improve the portability (the capability of transferring from one employee to another) of health insurance, combat fraud, abuse, and waste in health insurance, to promote the expanded use of medical savings accounts, and to simplify the administration of health insurance.
With today's use of electronic medical records software, information discussed in confidence with your doctor(s) will be recorded into electronic data files. The obvious concern is the potential for your records to be seen by hundreds of strangers who work in health care, the insurance industry, and a host of businesses associated with medical organizations. Fortunately, this catastrophic scenario will likely be avoided. Congress addressed growing public concern about privacy and security of personal health data, and in 1996 passed “The Health Insurance Portability and Accountability Act” (HIPAA). HIPAA sets the national standard for electronic transfers of health data.
Some of the things that HIPAA does for a patient are it gives patients more control over their health information. It sets boundaries on the use and release of health records. It establishes appropriate guidelines that health care providers and others must do to protect the privacy of the patients’ health information. It holds violators accountable, in court that can be imposed if they violate patients’ privacy rights by HIPAA. Overall HIPAA makes it to where the health information can’t b...
U.S. Department of Health and Human Services, Office for Civil Rights (2003). Summary of the hipaa privacy rule Washington, DC: Retrieved from http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/privacysummary.pdf
..., M., Thomas, E., Smolowitz, J., & Honig, J. (2007, Dec 07). Essential health care: affordable for all?. Retrieved from www.cinahl.com/cgi-bin/refsvc?jid=374&accno=2004209136
Levit, K. R., & Cowan, C. A. (1991). Business, households and governments: Health care costs, 1990. Health Care Financing Review, 13 (2), 83. Retrieved from: Ashford University Library
Barton, P.L. (2010). Understanding the U.S. health services system. (4th ed). Chicago, IL: Health Administration Press.
The Health Insurance Portability and Accountability Act (HIPAA), Patient Safety and Quality Improvement Act (PSQIA), Confidential Information and Statistical Efficiency Act (CIPSEA), and the Freedom of Information Act all provide legal protection under many laws. It also involves ethical protection. The patient must be able to completely trust the healthcare provider by having confidence that their information is kept safe and not disclosed without their consent. Disclosing any information to the public could be humiliating for them. Patient information that is protected includes all medical and personal information related to their medical records, medical treatments, payment records, date of birth, gender, and