In my own words how, HIPPA, ICD, CPT, and HCPCS influence each of the ten steps of the medical billing process is that when it comes to medical billing and the coding process, there is a special task that must be completed by the billing staff members of any medical facility, whether it is a small doctor’s office or a large hospital. They must provide quality care in the mean while protecting the patients’ privacy and expediting the payment of services rendered. There are ten steps to this process: pre-registration, establish the financial responsibility, the checking in and checking out of patients’, reviewing the coding compliance, checking the billing compliance, preparing and transmitting the claims, monitor payer adjudication, creating patient statements and the handling of collections. HIPPA policies are carefully reviewed by the patient’s informing them of the process necessary in transmitting their claims and the facilities devotion to their confidentiality.…
References: Lombardi, D. J., Schermerhorn, J. R., & Kramer, B. (2007). 4. In Health care management. [Adobe Digital Editions].…
This section respectfully appeals the decision by Blue Shield of 12/13/2016 and Reference Number: H43381807 to deny me prior authorization for an overnight inpatient stay – a stay that was intended to de-risk any initial periprocedural complications that might follow my previously authorized outpatient surgery.…
After auditing the remittance advice logs and medical records for a sample of cardiac rehabilitation claims, the Revenue Cycle Team has determined that medical necessity is not being met for code 93798. Further, they have discovered that a new LCD…
Within the culture of the St. John Health System (SJHS), risk management is considered the responsibility of every SJHS associate, from the CEO to the maintenance man. Each associate has an obligation to perform their jobs safely and to eliminate or at least minimize the risk of harm to any resident, visitor, or employee. The collection and utilization of data is also essential to a successful risk management program. Effective risk managers recognize the importance of data which may be used to identify residents at risk for falls, wounds, and infections for instance. When carefully collected and analyzed, this information may help the LTC manager identify at risk residents and target the resources needed to address their issues. Sources of data include the minimum data set (MDS) that provides information about residents resulting from multidisciplinary assessments. This information is also used for Medicare reimbursement, standards that identify the facility’s quality of care, and for state…
CO 8: Apply concepts of quality and safety using structure, process, and outcome measures to identify clinical questions as the beginning process of changing current practice. (PO #8)…
In 1944, the Servicemen’s Readjustment act, also known as the G.I Bill, was passed by legislation to provide monetary and educational support to World War II Veterans. These programs included; low mortgages, reduced tuition at universities, and providing veterans with social services, such as unemployment benefits. The low mortgages led many Americans to move out of the overcrowded cities and into the suburbs where it was now affordable to buy a home. Because more Americans were buying homes, the wealth of American families increased greatly; wealth that would stay in the family for decades. Education also made a difference for World War II Veterans and their families. Veterans were able to receive low tuition, therefore, making it easier to…
References: JCAHO (Joint Commission on Accreditation of Healthcare Organizations) Joint Commission Standards. 2000. Retrieved from www.jcaho.org/standard/jcstandards.html…
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2013). Module 7. Measuring and benchmarking clinical performance (13-0046-EF). Retrieved from website: http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod7.html.…
Ensured quality control through admissions, assessment, treatment, and referral for a broad range of patients…
Protocols and checklist have been shown to reduce patient harm through improved standardization and communication. Standardization is a process used with data analysis in the decreasing or prevention of errors, as well as…
post-acute, and evaluating readmissions and the effects on the hospital. This is a form of…
For some of the most common conditions treated in hospitals, as many as one in five patients is readmitted within 30 days of his/her discharge, reports the Federal Agency for Healthcare Research and Quality. Being readmitted has consequences. For one, readmissions cost Medicare an estimated 17.5 billion a year, as hospitals bill the government for the care. But the toll readmission takes on patients and their families is incalculable. “The most important problem of readmission is not the cost, but the fact that patients are ending up back in the hospital,” David C. Goodman, M.D. co-principal investigator of the Dartmouth Atlas of the Healthcare, said. “That means they have gotten sicker, or that there is a failure to care for them in the community.”…
The Centers for Medicare and Medicaid Services have taken on initiatives to improve quality of care for Medicare patients since the Affordable Care Act was passed in 2010. In 2012 CMS implemented a program called The Hospital Readmissions Reduction Program (HRR), this program is intended to improve health care for patients with Medicare to improve the quality of care that is provided versus the quantity of care. This program provides incentives to hospitals, which is intended to reduce costly and unnecessary readmissions (Centers for Medicare and Medicaid Services, 2016). The conditions that are currently being monitored by CMS for readmissions are heart attack, heat failure, and pneumonia. If hospitals have a high percentage of readmissions…
When it has been determined that a patient is medically ready for discharge, the health care team must determine the most appropriate setting for ongoing care. Determinants of the appropriate site of care involve medical, functional, and social aspects of the patient's illness. The patient’s acute and chronic medical conditions, potential for rehabilitation, and decision-making capacity must be taken into account.…