Understanding Health Insurance: A Guide to Billing and Reimbursement (MindTap Course List)
14th Edition
ISBN: 9781337554220
Author: Michelle A. Green
Publisher: Cengage Learning
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What is the value of interoperability in ahealth care setting? Provide specific examples.
What are limitations you see today ininteroperability? Explain.
What are the improvements needed to improve interoperability in the future? What impacts would these have?
Coordination of benefits (COB) includes:
Reimbursement when a patient is covered by more than 1 health plan
Reimbursement for non-covered services
Reimbursement for not medically necessary services
Reimbursement for diagnosis mismatch
Here is the image of a medical visit for patients. Our team is looking for improvement in both patient and physician satisfaction. As shown in the image below,
1.patients currently arrive at the medical office and complete an information form.
2. Some patients have appointments, but others are walk-ins.
3. An office assistant places the completed forms in a folder with the patient’s chart while answering the phone, assisting other patients, and dealing with paperwork.
4. The provider pulls the chart, provides the medical service, fills out forms for prescriptions and services provided, and returns it to the front desk.
5. The billing department enters the fee ticket, hopefully without errors, into a claim form to be mailed to the insurance company.
6. The insurance company receives the claim form and checks to see if it was sent to the correct company, if the form was completed correctly by the provider, and if the procedure was covered. If any of the above criteria are not met, the…
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Need a deep-dive on the concept behind this application? Look no further. Learn more about this topic, health-nutrition and related others by exploring similar questions and additional content below.Similar questions
- What is the value of interoperability in ahealth care setting? Provide specific examples. What are limitations you see today ininteroperability? Explain. What are the improvements needed to improve interoperability in the future? What impacts would these have? Provide atleast one source to support your ideasarrow_forwardValley View Hospital faces somewhat seasonal demand. Patients defer elective surgery in the summer and in the holiday season at the end of the year. As a result, the forecast of patient days of demand is as follows (a patient day is one patient staying for one day in the hospital): Forecast Fall 90,000 Winter Spring Spring Summer 70,000 85,000 65,000 The hospital uses regular nurses, part-time nurses (when the hospital can get them), and contract nurses (who are not employees). Contract nurses work a num- ber of hours which varies depending on their contract established with the hospital. Regular nurses are paid a sum of $15,500 per quarter for 60 days of work; part- time nurses are paid $6500 per quarter for 30 days of work. Contract nurses get an average of $17,200 per quarter for 60 days of work. It costs $1000 to hire or lay off any of these three types of nurses. Suppose that regular nurses are set at a level of 800 nurses for the year. Each regular nurse works the equiv- alent of…arrow_forwardDescribe what a compliance program is and explain the value of a compliance program for a healthcare facility and what the need for the compliance officer’s full authority?arrow_forward
- Explain how the patient perspective revenue cysle differs from the provider perspective revenue cycle in ensuring revenue integrityarrow_forwardWhat are the requirements of the PSDA? PSDA Stands For: Patient Self Determination Act of 1991arrow_forwardDescribe what a computerized provider order entry (CPOE) system is. Would you say it diminishes medication errors or it makes it more complicated and creates more errors for the nurse. Provide concrete examples to illustrate your point.arrow_forward
- With the use of Electronic Health Records most healthcare facilities and offices no longer submit a paper claim form instead of the fields in the EHR translate in the background to an electronic format of the CMS 1500 (physician claim) or a UB04 (hospital claim) form. However, it is still essential that you understand how to complete a claim form properly. In reviewing the different Blocks on the CMS 1500 form, choose a section of Blocks (as discussed in the unit) and in your own words: List the Block Numbers (i.e., Blocks 1-8), Describe what information goes into the Blocks Discuss any formatting requirements for the Blocks and what happens to a claim if the formatting is incorrect. In the second document above, CMS discusses Incomplete or Invalid Submissions. Explain how the Part A/Part B Medicare Administrative Contractors (MAC) handles these types of claims. CMS also discusses the difference between a “clean claim” and “other-than-clean claims.” Explain in your own words the…arrow_forwardScenario: You are the MOA in a busy family practice. The following calls come in to your office. For each situation, respond in the most appropriate manner. How would you handle each call? If it is for your physician, do you put the call through? Do you take a message? Can you handle the call yourself? Provide a brief explanation for each example.“Hi, I am wanting to have my prescription for Valium refilled by the doctor. Could he just phone it in to my pharmacy?”arrow_forwardA nurse manager is attempting to update a physician’s officefrom paper to electronic health records (EHR) by using theeight-step process for planned change. Place the followingactions in the order in which they should be initiated:a. The nurse devises a plan to switch to electronic healthrecords.b. The nurse records the time spent on written records vs.electronic health records.c. The nurse seeks approval from management for newcomputersd. The nurse analyzes all options for converting to electronichealth records. e. The nurse installs new computers and provides an in-service for the staff. f. The nurse explores possible barriers to changing to elec-tronic health records. g. The nurse follows up with the staff to check compliancewith the new system.h. The nurse evaluates the effects of changing to electronichealth records.arrow_forward
- A hospital is experiencing a marked increase in medication errors due to inadequate patient identification. The review of the risk management plan reveals the need for additional patient safety initiatives. Which new risk management recommendation should be implemented? Train staff on medication dosage calculations Evaluate the pharmacy packing system Provide an orientation on medication dispensing equipment Use bar codes for medication administrationarrow_forwardDiscuss the financial impact of initially declined claims and delayed payments to healthcare organizationsarrow_forward
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