BCBSM will implement changes to how it maps proprietary non-payment codes to standard codes beginning in August 2009. The changes were made based on provider feedback and are intended to improve the quality of 835 remittance reports. Three documents listing the new mappings are available on BCBSM's website until August 31. Providers should share this information with relevant staff and notify BCBSM of any questions or concerns regarding the revised mappings.
This document lists modifiers that affect payment for medical procedures. It includes CPT and HCPCS modifiers and describes how payment is determined when each modifier is used, such as paying 150% of the fee for bilateral procedures (-50) or 100% of the fee for unrelated E/M services (-24). Local modifiers are also provided, such as -1S for surgical dressings supplied for home use.
This document outlines various claim statuses and the relevant information and actions associated with each status. The statuses include claims that are not on file, in process, forwarded to the payer, paid, paid to the wrong address, denied for untimely filing, eligibility, non-covered services, need for a primary EOB, COB, capitation, lack of authorization or referral number, being bundled, incorrect provider, maximum primary payment, wrong diagnosis, modifier issue, pre-existing condition, medical necessity, untimely follow up, duplicate claim, pending additional information, applied to deductible, or paid to the patient.
This document provides an overview and instructions for electronic medical billing and payment within California's workers' compensation system. It adopts national electronic billing standards established under HIPAA, and supplements them with California-specific rules. The guide explains requirements for submitting bills electronically using standard formats like the 837, and for electronic remittance advice and acknowledgments. It also covers transaction identification numbers, code sets, roles of participants, and requirements for duplicate/corrected/appeal submissions and documentation attachments.
This document outlines the policies and procedures of MBA Medical Billing Services, Inc. It includes sections on standards of conduct, confidentiality, access to patient information, workstations, the claim generation process, waivers and discounts, standard adjustments, bankruptcy, mail return accounts, bad debt and collections, credit balances, patient rights, access and amendment to health information, use and disclosure of protected health information, de-identification, minimum necessary information, handling of privacy complaints, assessing risk areas, roles as a clearinghouse and business associate, second tier business associates, developing proposals and service agreements, services, responsibilities and fees, interruption of client service, physical security, system logs, contingency planning, and disaster recovery.
This document provides guidelines for best practices in quality assessment of healthcare documentation. It establishes principles of quality such as verifiability, definability, measurability, consistency and integrity. It discusses factors that affect quality like blanks and roles and responsibilities. It covers personnel involved in quality processes like transcriptionists and quality editors. It outlines assessment policies, procedures, error categories and scoring. It emphasizes continuous quality improvement using the Plan-Do-Check-Act model and provides recommendations. The goal is to ensure documentation is accurate, complete and satisfies requirements for high quality patient care.
The document discusses the process of submitting, processing, adjudicating, and paying health insurance claims. It begins by outlining the benefits of electronic claims submission over manual submission, such as lower processing costs and fewer errors. It then provides a seven-step overview of how health insurers typically process electronic claims, including determining eligibility, applying pricing edits, adjudicating the claim, generating explanations of benefits, and sending payment. Finally, it emphasizes the importance of reviewing health insurer contracts and auditing claims to appeal inappropriately paid or denied claims.
This document provides a summary of Medicare claims processing procedures for inpatient hospital billing. It outlines the table of contents which includes sections on general inpatient requirements, payment under the prospective payment system (PPS) diagnosis-related groups (DRGs), additional payment amounts for disproportionate share hospitals, rural hospital flexibility programs, billing coverage and utilization rules, adjustment bills, swing-bed services, and billing instructions for specific situations such as transplants and foreign hospital services. It provides procedural guidance to Medicare contractors for processing inpatient hospital claims.
BCBSM will implement changes to how it maps proprietary non-payment codes to standard codes beginning in August 2009. The changes were made based on provider feedback and are intended to improve the quality of 835 remittance reports. Three documents listing the new mappings are available on BCBSM's website until August 31. Providers should share this information with relevant staff and notify BCBSM of any questions or concerns regarding the revised mappings.
This document lists modifiers that affect payment for medical procedures. It includes CPT and HCPCS modifiers and describes how payment is determined when each modifier is used, such as paying 150% of the fee for bilateral procedures (-50) or 100% of the fee for unrelated E/M services (-24). Local modifiers are also provided, such as -1S for surgical dressings supplied for home use.
This document outlines various claim statuses and the relevant information and actions associated with each status. The statuses include claims that are not on file, in process, forwarded to the payer, paid, paid to the wrong address, denied for untimely filing, eligibility, non-covered services, need for a primary EOB, COB, capitation, lack of authorization or referral number, being bundled, incorrect provider, maximum primary payment, wrong diagnosis, modifier issue, pre-existing condition, medical necessity, untimely follow up, duplicate claim, pending additional information, applied to deductible, or paid to the patient.
This document provides an overview and instructions for electronic medical billing and payment within California's workers' compensation system. It adopts national electronic billing standards established under HIPAA, and supplements them with California-specific rules. The guide explains requirements for submitting bills electronically using standard formats like the 837, and for electronic remittance advice and acknowledgments. It also covers transaction identification numbers, code sets, roles of participants, and requirements for duplicate/corrected/appeal submissions and documentation attachments.
This document outlines the policies and procedures of MBA Medical Billing Services, Inc. It includes sections on standards of conduct, confidentiality, access to patient information, workstations, the claim generation process, waivers and discounts, standard adjustments, bankruptcy, mail return accounts, bad debt and collections, credit balances, patient rights, access and amendment to health information, use and disclosure of protected health information, de-identification, minimum necessary information, handling of privacy complaints, assessing risk areas, roles as a clearinghouse and business associate, second tier business associates, developing proposals and service agreements, services, responsibilities and fees, interruption of client service, physical security, system logs, contingency planning, and disaster recovery.
This document provides guidelines for best practices in quality assessment of healthcare documentation. It establishes principles of quality such as verifiability, definability, measurability, consistency and integrity. It discusses factors that affect quality like blanks and roles and responsibilities. It covers personnel involved in quality processes like transcriptionists and quality editors. It outlines assessment policies, procedures, error categories and scoring. It emphasizes continuous quality improvement using the Plan-Do-Check-Act model and provides recommendations. The goal is to ensure documentation is accurate, complete and satisfies requirements for high quality patient care.
The document discusses the process of submitting, processing, adjudicating, and paying health insurance claims. It begins by outlining the benefits of electronic claims submission over manual submission, such as lower processing costs and fewer errors. It then provides a seven-step overview of how health insurers typically process electronic claims, including determining eligibility, applying pricing edits, adjudicating the claim, generating explanations of benefits, and sending payment. Finally, it emphasizes the importance of reviewing health insurer contracts and auditing claims to appeal inappropriately paid or denied claims.
This document provides a summary of Medicare claims processing procedures for inpatient hospital billing. It outlines the table of contents which includes sections on general inpatient requirements, payment under the prospective payment system (PPS) diagnosis-related groups (DRGs), additional payment amounts for disproportionate share hospitals, rural hospital flexibility programs, billing coverage and utilization rules, adjustment bills, swing-bed services, and billing instructions for specific situations such as transplants and foreign hospital services. It provides procedural guidance to Medicare contractors for processing inpatient hospital claims.
The document outlines the medical billing flow chart and revenue cycle management system. It involves verifying patient eligibility, coding medical records, entering demographic and charge data, transmitting claims to clearinghouses, receiving explanations of benefits (EOBs), posting payments, and following up on denials to increase collections. Key steps include eligibility checks, coding, data entry, quality audits, transmission, cash posting, and accounts receivable management.
This document lists modifiers that affect payment for medical procedures. It includes CPT and HCPCS modifiers and describes how payment is determined when each modifier is used, such as paying 150% of the fee for bilateral procedures (-50) or 100% of the fee for unrelated E/M services (-24). Local modifiers are also provided, such as -1S for surgical dressings for home use.
The document provides an overview of Integrated Claims Strategies' (ICS) innovative medical claims management program. ICS offers a full suite of integrated medical management services including call center services, early intervention case management, pre-certification and utilization review, medical bill review with PPO networks and out-of-network negotiations, and retrospective utilization review. ICS prides itself on customized, flexible programs and proprietary technology to achieve outstanding outcomes and savings for clients.
The document discusses a solution from Washington Consulting and EMC for improving healthcare providers' revenue cycle management. The solution aims to streamline billing processes, reduce errors and denials, and improve cash flow. It leverages EMC's Documentum xCP platform to automate workflows and integrate content across systems. Key benefits include expediting content development, decreasing administrative costs, and empowering managers to allocate resources more efficiently. The solution provides a comprehensive approach to managing accounts receivable from start to finish.
The document discusses 4 dangerous trends facing medical groups: 1) Regulatory and compliance burdens continue to increase with many new regulations and compliance dates in 2015. 2) Operating costs continue to rise significantly each year, especially for staffing which accounts for over half of practice costs. 3) Provider reimbursement is declining from both government and commercial payers, with Medicare payments being cut and penalties increasing. 4) Patient collections have become critical with declining reimbursement. The presentation provides strategies for practices to address these challenges through improving productivity, evaluating costs, and protecting staff.
The document provides an overview of medical billing standards and electronic billing in California workers' compensation. It summarizes the legislative history that mandated electronic billing standards, the development process involving stakeholders, and the final regulations. Key aspects of the standards include requirements for complete bills, timeframes for payment/denial of electronically submitted bills, penalties for non-compliance, and the use of standard forms and transactions such as the 837 and 835. National standards were incorporated to ensure consistency.
The document provides an overview of the UB-04 form which replaced the UB-92 form and was mandated for use in May 2007, it describes the various form locators that make up the UB-04 including those for patient information, billing information, diagnosis codes, and provider information. The presentation aims to educate Medicare Part A providers on properly completing the UB-04 form.
This document outlines a sample claims management process for a physician practice with 14 steps. The process begins with patient registration, verification of insurance benefits, and check-in. It continues with clinical documentation of services, assigning codes, patient check-out, coding review, pre-authorization if needed, claim generation, claim review, processing by the health insurer, collections if needed, posting payments, appeals if claims are denied, and ends with a glossary. Implementing this detailed process is intended to increase efficiency, submit clean claims, reduce denials, and ensure timely payments from health insurers.
TCS Healthcare presented at a virtual trade mission in Nashville on improving healthcare. They discussed challenges like rising costs, lack of access, and waste. TCS aims to enhance healthcare through increasing access, lowering costs, improving outcomes, and empowering patients through analytics, dashboards, and other technologies. They provide services including hospital management systems, clinical decision support, and business process outsourcing to healthcare payers and providers.
The medical billing process involves several key steps:
1) Patients make appointments and provide their information;
2) Doctors examine patients, document medical records, and provide medical coding;
3) Coders assign codes to medical records which are then sent to billing;
4) Billers enter patient and visit details, submit claims to insurance, and handle payments and denials.
The SlideShare 101 is a quick start guide if you want to walk through the main features that the platform offers. This will keep getting updated as new features are launched.
The SlideShare 101 replaces the earlier "SlideShare Quick Tour".
The document outlines the medical billing flow chart and revenue cycle management system. It involves verifying patient eligibility, coding medical records, entering demographic and charge data, transmitting claims to clearinghouses, receiving explanations of benefits (EOBs), posting payments, and following up on denials to increase collections. Key steps include eligibility checks, coding, data entry, quality audits, transmission, cash posting, and accounts receivable management.
This document lists modifiers that affect payment for medical procedures. It includes CPT and HCPCS modifiers and describes how payment is determined when each modifier is used, such as paying 150% of the fee for bilateral procedures (-50) or 100% of the fee for unrelated E/M services (-24). Local modifiers are also provided, such as -1S for surgical dressings for home use.
The document provides an overview of Integrated Claims Strategies' (ICS) innovative medical claims management program. ICS offers a full suite of integrated medical management services including call center services, early intervention case management, pre-certification and utilization review, medical bill review with PPO networks and out-of-network negotiations, and retrospective utilization review. ICS prides itself on customized, flexible programs and proprietary technology to achieve outstanding outcomes and savings for clients.
The document discusses a solution from Washington Consulting and EMC for improving healthcare providers' revenue cycle management. The solution aims to streamline billing processes, reduce errors and denials, and improve cash flow. It leverages EMC's Documentum xCP platform to automate workflows and integrate content across systems. Key benefits include expediting content development, decreasing administrative costs, and empowering managers to allocate resources more efficiently. The solution provides a comprehensive approach to managing accounts receivable from start to finish.
The document discusses 4 dangerous trends facing medical groups: 1) Regulatory and compliance burdens continue to increase with many new regulations and compliance dates in 2015. 2) Operating costs continue to rise significantly each year, especially for staffing which accounts for over half of practice costs. 3) Provider reimbursement is declining from both government and commercial payers, with Medicare payments being cut and penalties increasing. 4) Patient collections have become critical with declining reimbursement. The presentation provides strategies for practices to address these challenges through improving productivity, evaluating costs, and protecting staff.
The document provides an overview of medical billing standards and electronic billing in California workers' compensation. It summarizes the legislative history that mandated electronic billing standards, the development process involving stakeholders, and the final regulations. Key aspects of the standards include requirements for complete bills, timeframes for payment/denial of electronically submitted bills, penalties for non-compliance, and the use of standard forms and transactions such as the 837 and 835. National standards were incorporated to ensure consistency.
The document provides an overview of the UB-04 form which replaced the UB-92 form and was mandated for use in May 2007, it describes the various form locators that make up the UB-04 including those for patient information, billing information, diagnosis codes, and provider information. The presentation aims to educate Medicare Part A providers on properly completing the UB-04 form.
This document outlines a sample claims management process for a physician practice with 14 steps. The process begins with patient registration, verification of insurance benefits, and check-in. It continues with clinical documentation of services, assigning codes, patient check-out, coding review, pre-authorization if needed, claim generation, claim review, processing by the health insurer, collections if needed, posting payments, appeals if claims are denied, and ends with a glossary. Implementing this detailed process is intended to increase efficiency, submit clean claims, reduce denials, and ensure timely payments from health insurers.
TCS Healthcare presented at a virtual trade mission in Nashville on improving healthcare. They discussed challenges like rising costs, lack of access, and waste. TCS aims to enhance healthcare through increasing access, lowering costs, improving outcomes, and empowering patients through analytics, dashboards, and other technologies. They provide services including hospital management systems, clinical decision support, and business process outsourcing to healthcare payers and providers.
The medical billing process involves several key steps:
1) Patients make appointments and provide their information;
2) Doctors examine patients, document medical records, and provide medical coding;
3) Coders assign codes to medical records which are then sent to billing;
4) Billers enter patient and visit details, submit claims to insurance, and handle payments and denials.
The SlideShare 101 is a quick start guide if you want to walk through the main features that the platform offers. This will keep getting updated as new features are launched.
The SlideShare 101 replaces the earlier "SlideShare Quick Tour".