Healthcare Claims and Processing - 1600 Words

A current LCD for the regional Medicare intermediary (Michigan - Region V) is shown in the example below. This LCD is for Erythropoiesis Stimulating Agents, L25211. The LCD is active and became effective on 12/1/2007 with an date of 11/01/2013 for the 10/22/2013 revision (cms.gov, 2014b). Question 8: Report on the Health Insurance Portability And Accountability Act (HIPAA) and its impact on healthcare claims processing. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was created, in part, to make health insurance portable in an attempt to address the problem of the growing amount of people that are uninsured and underinsured (NASW,2002). The Act allows a person with preexisting medical issues to get health†¦show more content†¦Use of Version 5010 became effective January 1, 2012 and replaced version 4010A1 (cms.gov, 2014c). Question 9: Compare using a chart the classifications, taxonomies, nomenclatures, terminologies and clinical vocabularies used in healthcare claims processing. Question 10: Explain the role of The Office Of Inspector General (OIG) in coding compliance, auditing and reporting. Select one audit from the current OIG Work Plan and describe the focus and intent of the audit. In Michigan, the Office of the Inspector General (OIG) was created in 1972 by the Michigan Department of Health and Human Services to help maintain accountability in efficient and appropriate administration of HHS programs (OIG, 2013). The OIG investigates alleged fraud in these programs as well as reviewing policies and procedures and recommending improvements in ways to counteract and detect fraud. In addition, OIG monitors compliance with reimbursement regulations. OIG provides guidance documents for compliance programs for various types of providers to use to develop compliance programs in their facilities. The compliance plans include development of policies, including those for accurate coding, internal monitoring and auditing, naming of a compliance officer, and appropriate training (Peden, 2012). One of the Public Health Agencies that HHS audits is the Centers for Disease Control andShow MoreRelatedApplication Software Products Do Not Control How The System Works935 Words   |  4 PagesApplication Software Application software products do not control how the system works. They are designed to provide a service or a function to satisfy common and specific needs across industries. They allow computers perform daily tasks such as word processing, emailing, searching on the Web, etc.; and can be classified as: horizontal-market aplication software and vertical-market application software. Application software can be both, one program alone such as WordPerfect to edit and create documetsRead MoreDiagnostic Coding And Procedural Coding931 Words   |  4 PagesMedical Coding Essay Academic Essay Diagnostic coding and procedural coding lend themselves well to the improvement of healthcare efficiency. Both have accurate recording for diagnoses and the procedures enable the analysis of information for the patient’s care, research, performance improvement, healthcare planning and facility management. The diagnosis codes are divided into chapters, sections, subsections, and subcategories (1). A coder should become familiar with all of the codes before theRead MoreIs The Daughter Of An Immigrant?866 Words   |  4 PagesHealth Professions Program with a Master’s in Healthcare Administration (MHA), I will have the tools to creatively change, influence and impact what we call healthcare today. I chose Texas State over other Universities offering a MHA in Texas, because Texas State offers small classes that are taught by award winning and nationally-known instructors. I am also aware that Texas State’s MHA program is accredited by the Commission on the Accre ditation of Healthcare Management Education CAHME, the only organizationRead MoreBilling System Essay800 Words   |  4 Pagesas well as the nurse notes according to the patient office visit. For as the claim processing system, it is used on another program including the finance system. The data entered in the 3M program is manually entered by the receptionist which is the patient first person contact when entering the medical office, but the claiming and financial system the information is transferred from 3M to another program for processing payments. The system stored and saved the patient information for later accessRead MoreRelay Health Legacy Directory Essay925 Words   |  4 PagesIn case a practice wants to be paid for their services, the Relay Health Electronic Chart Software enables payments to be executed within a period of 24 hours or less by patients. This cuts down on paper claims. In the age insurance players prefer giving priority to processing electronic claims; at least two weeks are cut off in such transactions. In addition, the chart software assists in coordinating information regarding patient’s record with other similar service providers in the health sectorRead MoreInfluence On The Workplace Settings1339 Words   |  6 Pagesalmost every aspect of healthcare systems and processes. Patient access is impacted by ICD-10-CM/PCS in regards to information capture, registration, and medical necessity. The influence on clinical care is with disease and case management, DRG assignment and case mix management, clinical documentation and coding, care guidelines or protocols, and nursing documentation. Billing and financial systems are also affecting for health plan contracting, coding, claims processing, payment policy, and physicianRead MoreLeveraging Newly Acquired Skills to Benefit Society651 Words   |  3 Pagessociety at large. Those who succeed at their professional do so not only because they are good but also because they have a passion for what they do and they understand how th eir work is important in the big picture. Serving the needs of patients and healthcare providers as a medical biller, doing my job effectively and with accuracy is exactly how I intent to use the skills, tools and information acquired during my studies to benefit society. While I consider myself a flexible person, there are a fewRead MoreThe Function Of The Revenue Cycle917 Words   |  4 PagesThe revenue cycle is a complex process that encompasses all the steps that goes into processing a particular patient. The purpose of this paper is to analyze the key contributing factors of the cycle; in particular, the six stages of the cycle. Furthermore, the registration process will be highlighted, with emphasis placed on how it is tied to the revenue cycle. To get a more complete picture of the revenue cycle, one must first define what it is. According to Cleverley et al. (2010), the revenueRead MoreThe Impact Of Data Mining On The Healthcare Industry1451 Words   |  6 PagesData mining is used in various forms by different agencies. Detecting fraud and abuse is one of the benefits of the use of data mining. The healthcare industry is big and one of the biggest payers is CMS. However, detecting fraud and abuse in healthcare claims is crucial because billions of money is being wasted in unnecessary care. Data mining is defined as the process of data selection and studying and building models using massive data stores to disclose previously unidentified patterns in databasesRead MoreThe Long Wait Time For Medical Treatment885 Words   |  4 PagesThe average time for a Veteran to see his primary care provider for the first time, when switching to the Veteran Affairs Healthcare system, is over ninety days. Since the DoD healthcare system uses different processing procedure, than the Veteran Affairs Healthcare system, many patients are unable to get continued healthcare. In many cases the review of the disability claims package takes too long. Even though the Inspector General of the VA has called for a fourteen day target time frame for scheduled