D-Met with the patient upon his arrival. This writer addressed with the patient about TEAM's decision of not reinstating him for treatment due to his non-compliance of his multiple AWOLs and following through with Hartford Dispensary with regards to making his payment to the clinic. According to the patient, he did everything on his end with the Hartford Dispensary, but the clinic wants him to be taper off on his methadone. This writer questioned the patient if he had obtained a letter from his prescriber stipulating that he cannot get off on his benzos script and no response to this question. When the patient was questioned as to whether or not he did indeed paid the Hartford Dispensary, he says, " I did, but if I have to do it again, I will."…
RCM unifies the clinical and business side of healthcare using both primary and secondary patient data, insurance, and provider and the revenue cycle is vital in creating compliant and efficient reimbursement processes. The revenue cycle is divided into four which are preclaims activities, claims processing, account receivable and claims reconciliation and collection. The preclaims submission is the first process in the cycle which begins with patient case management and preregistration such as collection insurance information before patient arrives then collecting subsequent patient information to create a medical record number to meet financial, clinical and regulatory requirement and Medicare patient are advised on financial responsibilities if…
1. Please describe your knowledge of the Michigan Public Act 593 (PA593). My previous experience with the Michigan Public Act 593 includes direct working experience with the legislation as a claims examiner at Meridian Health. In addition, I was to complete the course “Legal Aspects for Health Services Organization” for the completion of my Masters in Health Service Administration.…
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.…
A review of the records reveals the member to be an adult female with a birth date of 06/06/1956. The member has a diagnosis of rheumatoid arthritis. The member’s treating provider, Laura Summers, MD recommended the member continue her treatment of Remicade infusions 7 mg/kg every 6 weeks. The carrier has denied coverage of Remicade infusions 7 mg/kg every 6 weeks as not medically necessary.…
The CMS 1500 and the UB04 are two types of claims forms used to submit charges for reimbursement. The UB04 (also called CMS 1450) is mainly used for facility claims, such as hospitals, surgery centers, and nursing homes. They cover both inpatient and outpatient charges, along with any associated with diagnostics, supplies, and lab work. This forms shows the “resources used” by the facility. When this form is submitted electronically, it is called the 837-I, with the “I” standing for Institutional.…
Typhanie Clemons Experience Claims Research/Customer Service Representative (Temporary) 03/2015-05/2017 MD Wise, Inc. (Damar Staffing) • Accurately submitted claims for reprocess in accordance with the claims processing system and other department guidelines • Investigated and resolved claim concerns • Reversed and reprocessed claims as necessary • Managed inbound calls to resolve payment issues and take payments over the phone • Responded to specialized claims inquiries from patients and providers • Properly handled and documented calls in timely fashion • Ensured that appropriate follow-up to claims inquiries/requests is complete and timely Rehabilitation Specialist 02/2012-06/2014…
On 9/6/17 I met Mr. Reid at the office of Dr. Rampersaud. I have printed and provided Mr. Reid the information on how and where to get medications filled along with a form for him to fill out for reimbursement of prior out of pocket expenses. I also provided Dr. Rampersaud with a letter with requirements and instructions on filling medications. I met Mr. and Mrs. Reid at the appointment with Dr. Rampersaud.…
This investigation stems from Dr. Fonn self-reporting that he his privileges had been suspended for 30 days from a hospital in Cape Girardeau, MO. It was due to alleged conflict of interest and federal prosecution for Anti-Kickback law violations. He also answered positive to remuneration for two cases in the past year. A case was opened.…
The first line which is line 1 and line 1a should have insurance information like Medicare Tricare if applicable to patient. Line 2, 3, and 5 should have a patients demographics such as name, age, race, gender and address, while line 4, 6, 9, 11 a, c, d should have insured patient’s insurance information like group number while line 10 should have a patient’s employment status while line 12 and 13 is a patient’s authorization which is their signature. The bottom portion of the CMS 1500 02/12 claims form is the clinical portion. Block 21 is the diagnostic codes for a patient’s condition, while Block 24 is date of services and prices for services. Block 25 is the Employer identification number (EIN) which is a federal tax ID.…
Hello, Dr. Sheth, Per our conversation earlier this week I have included a copy of the hospital bill. From the insurance company I was able to figure out that the total amount billed to Aetna was $17,667.10, which includes a discount of $11,917.10. Aetna paid $16,798.43 and left me responsible for the remaining $868.67. When I asked why it wasn’t covered completely, they told me that I overstayed my hospital visit for 3h and 5min.…
I am working on the American Nicaraguan School Module and reviewing the Codes That Rule GEM06 spreadsheet (per our Instant Message yesterday (09.28.15) afternoon). May I receive your assistance in providing the following clarifications: 1. May I get the Network Type Codes?…
First of all, it’s not an “unidentified fax”, it clearly has Dr. Who’s name. The procedure for unidentified fax does not apply. 2nd, I followed the instruction regarding all correspondence with Doctor/Psychiatrist/Consultant’s name on it (who does not have a fixed office in CTYS), should be forwarded to the related program manager. This has been the practice for over 16 years.…
Good evening Bob, I just wanted to give you an update from my doctor's visit today. The doctor has stated that I am not ready to return to work yet due to another issue that I have developed, which will require physical therapy due to a pinched tendon causing pain. Because of this pinched tendon, I am not able to fully extend my foot to walk straight and the doctor feels that this problem would best respond to physical therapy. Enclosed with this email I have sent you a copy of the medical request form with the explanation that I have been sent to Cigna. I start physical therapy on Monday, March 28, 2016 and my follow up with the doctor for this is on April 12, 2016.…
Compare and contrast Medicare and Medicaid; including funding sources, fraud and/or abuse, and eligibility requirements for recipients: Medicare: A federal health insurance program for people who are 65 or older. Under 65 with certain / of any age and have End Stage Renal Disease (ESRD) or ALS. It is governed by the Federal Government and depending on the coverage you choose and may include: Care and services received as an inpatient in a hospital or skilled nursing facility (Part A) Doctor visits, care and services received as an outpatient, and some preventive care (Part B) Prescription drugs (Part D). (Part C)…