They are both versed in every aspect of the billing process, and, ensure that our specialsits are following our follow up and documentation procedures. Their attention to detail, and adherhence to DM Medcial Billings processes, have resulted in excellent collection rates, and have seen them each move into mangement and supervisory positions, within DM Medical Billings. Resumes are attached. DM Medical Billings has never had any lawsuits and or public judgments in its 19 year history. DM Medical Billings performs background checks, and all potential employees are screened prior to being made an offer of employment.…
Insurance company reimbursement rates are seldom available to the public. Most patients are privy to these reimbursement rates only after their claim is processed. After reviewing the charge rates and reimbursement rates of Sutter Health, a system of not-for-profit hospitals and physician groups, disparities between hospital charges and disparities between insurance reimbursements were identified. The results revealed that a hospital charges different rates for the same procedures.…
Week 3 DB Billing 2 Discuss different types of benefits available to veterans and their family members, giving specific details and examples. Active duty service members and their families can receive health benefits through the following TRICARE plans listed below. To be eligible the uniformed service member (sponsor) and their families (beneficiaries) must be enrolled in the Defense Enrollment Eligibility Reporting System (DEERS) TRICARE deductibles renew on OCT 1st. Patient responsibility is referred to as “cost share”.…
For placement of the NPI number a biller should refer to block 17a, 17b, and 24, when ordering and supervising doctors are different individuals. The ordering doctor should be in Block 17 with NPI number going in Block 17b, the NPI of supervising doctor goes in Block24j and supervising physician goes in Block 31 and group NPI in Block 33a. Once all of these blocks and lines are filled a biller should double check documentation, like insurance subscriber numbers, , copay amounts, point of contact details of visit, appropriate CPT codes for services provided, use all upper case letters on form and don’t use symbols like N/A…
I didn't realize how big of a role the medical biller played in the medical field until I was able to read a little more the jobs that they perform. There are so many things that can go wrong if a facility didn't have a medical biller. They play a big role in the interaction between the healthcare providers and insurance companies.…
The practice of double billing is unethical it is at heart theft and as such illegal. The act violates the ethical principles of justice and fidelity, when a patient is seen there is an expectation that the doctor will properly bill them and provide services for in good faith for the agreed upon amount. TO double bill violates this trust, and constitutes breaking an agreement made between the doctor and the patient. To double bill medicaid is also unjust in that it removes from a system that is deigned to provide for the well-fare of a segment of society in this case the elderly. The funds taken constitute either less services being provided or the need to acquire further funds through practices such as increased taxes or co-pays.…
The Affordable Care Act legislation has been the catalyst for changing how health care is delivered in the United States. A plausible next step is to evaluate how health care is being paid and by whom. The government and larger private insurers are very powerful and have a palpable influence on health care options. Moving to a government operated one payer healthcare system is intriguing and has been accomplished in Canada and other countries.…
Orfield, C., Hula, L., Barna, M., & Hoag, S. (2015), also support this stating, patients having a relationship with their providers, improve quality of care, cause an reduction in hospitalization, decrease in emergency room visits and results in greater patients satisfaction. In terms of the numbers of primary care providers, all eight plans have a wide range and numbers of provider to choose from, and obtaining an appointment should not be an…
Like I stated in the beginning fraud is defined as the “wrongful or criminal deception intended to result in financial or personal gain” (Definition of Fraud in English by Oxford Dictionaries). There can be many things that can indicate or give a trigger to fraud some examples of fraud are, Phantom Billing which is billing for services that were never performed to that patient Inflated Hospital Bills: overcharging for procedures and /or equipment used on that patient. Service Unbundling or Fragmentation: billing for the procedures separately when they should all be billed in a bundle. Repeat Billing: Billing the patient twice for something that they only received once. Correct charge for type of room: When they bill you for a private room…
References: Managed Care/Hmos. (2013). In Gale (Ed.), Gale encyclopedia of everyday law (3rd ed.). Farmington, MI: Gale. Retrieved from http://search.credoreference.com.proxy-library.ashford.edu/content/entry/galegel/managed_care_hmos/0 Moon, M. (2015).…
This plan you can choose a primary care physician (PCP). Having a primary care physician enables you to get referrals like a PPO.”(Bolston,2015). Define the Challenges and Problems Associated With Your Topic There are always pros and cons to anything that is one a mass level. The managed care is no different. There are several things…
Some managed care organizations do not provide certain health care services within their networks, i.e. mental health or pain management. Plans will allow for patients to seek services out of network to deal with ailments, cost varies. The usage of PPOs has provided a way for people to maintain their primary care physician (PCP) outside of networks. Patients surveyed a 2003 study showed that continuity of care is very important but the majority were unwilling to spend additional time or money to maintain the relationship with their PCP. Patients with chronic diseases and older patients were willing to do more in order to keep their current PCP (Pereira and Pearson, 2003).…
Taking a look at the amount that the insurance does cover and then comparing it to the portion that we have to pay there wouldn 't be enough for other bills. That will cause you to work extra hours just to get back what was lost to catch up. The insurance companies should take that into consideration because they wouldn 't like if it was them in that situation. They have the ability to reevaluate the cost but they are just looking at how much money is coming into their company. I don 't think that 's fair.…
This unique relationship often allows HMOs to maintain a lower cost of service from plan providers. Because the HMO is both a provider and an insurer, this allows for lower administrative cost to the patient. Preventive care is offered through HMO’s, this is a way they try to reduce cost, through early detection and wellness programs. Thus, inexpensive visits to the primary care physician the chance for early detection of costly diseases can be preventative.…
My discourse community is a group of scientists who understand a basic set of values and assumptions, and ways of communicating about the goals of being a Medical Laboratory Scientist (MLS). MLS like every healthcare profession requires someone with a big heart who not only shares in interest in the career, but whose main goal is to help people. There are specific fields related to a medical laboratory technician, such as, hematologist, immunologist, microbiologist, and blood banking. The healthcare system is an extremely large field with doctors, nurses and other medical staff.…