This case is about Dr Melissa Walker, she is a top-level orthopaedic surgeon who has either studied or worked almost all of her life. While on holiday in Santa Fe she met the love of her life, Michael Langford. He worked for a publishing company as editor in chief. They got married within 6 months after they met.…
The plaintiff, Cynthia Holderfield filed this case on behalf of her sister and legal ward, Elise Ann Wasson, a disabled adult. The complaint alleges that as a result of the insured’s neglect, Elise sustained significant and permanent injuries following a fall on January 17, 2016, while she was a resident at one of our insured’s Community Integrated Living Arrangement homes. The plaintiff further alleges that the insured neglected Elise when it failed to take the necessary precautions to prevent her from falling. II.…
Working in the medical billing industry can be daunting at times. My last position as a follow up representative, proved to be the most challenging job that I have ever had. I have an extensive background in the medical insurance industry. I was aware of the way that claims were to be handled and submitted to insurance companies. The company that I had worked for had just won a contract for taking over the medical billing for twelve physicians in Portland, Oregon. Right off the bat, there were a variety of issues concerning how to bill the medical claims correctly. Claims have to be submitted on time, with the correct codes and information on them, before they can be processed by the insurance company.…
Everything that is done in this world has to have a process whether it is an act as simple as cooking a meal or something more complex like the 10 steps to medical billing. If one of these processes or steps is left out, then the result can be disastrous. A cook would not leave out the eggs or the bread when making French toast. The medical billing process is the same, some steps more important than others but each still equally needed.…
This report describes how Intermountain Healthcare is looking at using the government enacted Stark regulation system. This system uses RVUs (relative value units) in determining compensation for individual physicians. The report will go over why the Stark regulations were created and how RVU’s are utilized within the system. The report also includes a questionnaire…
Because this is an important step, many facilities use a professional to prepare the claims and send them out. A claim contains a patient’s diagnosis, treatment, and charges to the coverage company. These claims need to be extremely accurate and filed on time. Monitoring the payer adjudication is step eight, it helps the coverage companies decide if they should pay the full claim, part of the claim, hold off until further information is obtained, or denied completely. After the decision is made, a letter is sent back to the facility and a specialist makes sure that all the payments are accounted for and the reasons for denial are given. Many times the coverage company does not pay the full amount and here is where step nine comes in. What the company will pay is deducted from the patient’s bill and the final bill is given to or sent out to the patient to pay their…
There are ten basic steps in the medical billing process. Each step has certain things which must be done to correctly complete the entire process. In order to complete your duties as a medical biller efficiently, you must follow the medical billing process. Following this process leads to maximum and appropriate payments in a timely fashion. These steps range from the pre registration of the patient to the collection of the payment. In this paper each step will be describe with a brief outline of what each step entails.…
The medical billing process and all of the functions that pertain to it are the responsibilities of the medical insurance specialist. It addresses all tasks that will be performed by the administrative staff members during the medical billing process. These functions are typically handled by front office staff members such as the receptionist (registration) and scheduling.…
The need to correctly document medical records, apply appropriate billing codes, and accurately charge payers for medical procedures and services is essential for today’s medical facilities. Physicians rely on medical insurance specialists to process claims so that they can be reimbursed for their services. This essay will emphasize the importance of correctly submitting claims for reimbursement, as well as, how compliance plans are put in place to benefit everyone involved in the billing and coding process.…
We are all familiar with the ruling of the Tarasoff v. Regent of the University…
Billing and coding is very important in medical facilities, not only to the facility but also the patients and their insurance carriers. Sometimes, mistakes are made during this process that can cause delay in payment or denial of a claim.…
References: Bayes, N., Newby, C., Seggern, J., & Valerius, J. (2008). Medical Insurance: An Integrated Claims Process Approach (3rd ed.). Retrieved from http://www.axialibrary/phoenix.edu…
The New York State Insurance Fund arrested two Long Island builders and one claimant in separate cases of alleged workers compensation fraud with a potential total of more than $1 million.…
The banks of Canada first started in 1980 which were the only banks in the sector. By 1999 foreign banks were given permission to give full service. There were two parts to ING. One was an international ING group in the located in Netherlands that help worldwide from banking to asset management. The other is the ING Direct Bank located in Canada. In 2000, Basil Bell who was senior vice president of operations at ING Direct in Toronto, Canada was concerned with the banks growing client base that it was causing problems like it was impossible to increase staff since he had to have a limit of staff. For example, he believed that the back house had reached the limit in which how many staff members could be working there. So he sent Hadley MacDonald to take care of that situation. So he came up with the solution of using technology to fix the problem for both limiting staff and improving operations. And started off by taking a look at the process of opening new accounts. Because there was no forecasting or benchmark measurements to see how or when they could increase staff. So they decided that improving steps in getting new accounts to decrease workload. The reason about keeping staff to a minimum was because they would have to get paid even more for any overtime they did and that not what the ING bank wanted to do. The second step they took in improving was the mailroom. The mailroom got two new machines that would improve speed of mailroom operations. They also improved systems like in CIFing of new applications. And there were more improvements done. Bell wanted these changes to have long term investments.…
Phakwe Group’s Chairman and CEO, Mr Thabiso Tenyane has managed to leverage his experience and expertise in both the public and private sector to make his group of companies formidable participants in several sectors of business. Since its creation in 2008, Phakwe flourished into a company now worth approximately half a billion rand and has offices around the world starting in South Africa, Mauritius, DRC, Italy and Dubai. Phakwe Group consists of Phakwe Consulting, Phakwe Aviation, Phakwe Telecommunications, Phakwe Investments, Phakwe Power, Phakwe Engineering and Phakwe Petroleum. Currently Phakwe provides a broad spectrum of services to the governments and private clients worldwide. Phakwe Power has a stake in the Metrowind…