Medicalbillingstar is one of the largest firm in USA which provides medical billing ,coding and claims services.For more Info call us @ 1-888-571-9069.
Claims Management - Edge through Efficiencyneetamundra
The objective of this paper is to talk about the current state of the claims process and how an efficient and ideal claims system should be. This document is most relevant for the Indian insurance industry.
Common challenges faced by Physicians and Practitioners with Medical Billingjennyvergeese
Medical billing refers to the process of filing and following up on claims with health insurance companies / providers in order to receive payments for the healthcare services rendered to patients by the practices / physicians. Medical billing serves as an effective channel between medical service providers and insurance companies.
Drucker Law Offices
12161 Ken Adams Way #110-C2,
Wellington, FL 33414
(561) 812-5693
http://www.floridalawteam.com/wellington/
At Drucker Law Offices, the firm is absolutely devoted to the service that is given to its personal injury clients. Gary J. Drucker and the Drucker law firm will guide you through your case, from beginning to end with a focus on personal attention. You do not have to face a large corporation or insurance company alone. Gary J. Drucker and Drucker Law Offices will be there for you every step of the way, advising you through each stage and protecting your rights throughout.
Review Figure 10.1 on p. 239 and the Billing Workflow section .docxcarlstromcurtis
Review
Figure 10.1 on p. 239 and the Billing Workflow section on pp. 238-239 of
Health Information and Technology Management
.
Write
a 150- to 350-word response to the following:
Discuss
at least two components described in the Billing Workflow section in Ch. 10 of
Health Information and Technology Management
.
How do these components affect health care reimbursement?
Billing Workflow
1.
Providers of all types verify patient insurance eligibility with the health plan, either prior to or during the admission or visit. Medical offices collect and post copays at the visit.
2.
The patient is treated and discharged or checked out.
3.
As you learned in
Chapter 9
, the provider usually needs to bill a third party, the insurance plan, in order to receive payment. The insurance bill is called a
claim
. The first step in preparing the claim is to assign procedure codes for the services rendered and the supplies used and diagnosis codes representing the disease or medical condition.
4.
Using these codes and the patient registration information, a computer program generates a paper or electronic claim to be sent to the insurance plan.Before the claim is sent to the insurance plan, an insurance or claim specialist reviews the claim to make sure there are no errors. Because of the volume of claims, a computer program is used to examine the claim data and identify problems. Once the claim is correct, it is sent to the insurance plan (usually electronically).
5.
When the claim is received by the insurance plan, it is adjudicated. If the claim is correct, a payment is sent to the provider; this is called the
remittance
. A paper or electronic document is generated that explains the amounts that were paid. This is called the
remittance advice
or
explanation of benefits
(EOB).
6.
When the remittance is received by the provider, the payment amount is recorded in the patient accounts system. Frequently, the amount billed does not equal the amount paid. This may be the result of a contractual agreement that stipulates that the provider will accept a discounted payment and/or that a portion of the charges is the patient’s obligation. An accounting entry called a
write-down adjustment
is posted to adjust the charge.
7.
If the patient has a secondary insurance plan, a claim is next sent to the second plan. In certain cases the first plan will automatically forward the claim to the second plan. This is called a “piggyback” claim or
coordination of benefit
(COB) claim. For example, when a Medicare patient has a supplemental insurance policy with the fiscal intermediary who processes the Medicare claims, the company will sometimes process the secondary claim automatically. This eliminates the need for the provider to file a second claim. These are also known as crossover claims.
8.
Most health plans require the patient to pay a portion of the medical bill. These payments are referred to as the copay, coinsurance, and deductible amou ...
Summary description of an existing system that prevents doctor shopping. Patient prescription patterns are checked for the doctor before writing a new prescription. For the pharmacist, the claim is matched against valid prescriptions, and the filling of similar prescriptions are checked before drugs are dispensed.
Describes a joint CMS/WellPoint voluntary project that demonstrates the effectiveness of Castlestone's VisitEye in preventing many forms of outpatient insurance fraud, in this case Durable Medical Equipment (DME)
Claims Management - Edge through Efficiencyneetamundra
The objective of this paper is to talk about the current state of the claims process and how an efficient and ideal claims system should be. This document is most relevant for the Indian insurance industry.
Common challenges faced by Physicians and Practitioners with Medical Billingjennyvergeese
Medical billing refers to the process of filing and following up on claims with health insurance companies / providers in order to receive payments for the healthcare services rendered to patients by the practices / physicians. Medical billing serves as an effective channel between medical service providers and insurance companies.
Drucker Law Offices
12161 Ken Adams Way #110-C2,
Wellington, FL 33414
(561) 812-5693
http://www.floridalawteam.com/wellington/
At Drucker Law Offices, the firm is absolutely devoted to the service that is given to its personal injury clients. Gary J. Drucker and the Drucker law firm will guide you through your case, from beginning to end with a focus on personal attention. You do not have to face a large corporation or insurance company alone. Gary J. Drucker and Drucker Law Offices will be there for you every step of the way, advising you through each stage and protecting your rights throughout.
Review Figure 10.1 on p. 239 and the Billing Workflow section .docxcarlstromcurtis
Review
Figure 10.1 on p. 239 and the Billing Workflow section on pp. 238-239 of
Health Information and Technology Management
.
Write
a 150- to 350-word response to the following:
Discuss
at least two components described in the Billing Workflow section in Ch. 10 of
Health Information and Technology Management
.
How do these components affect health care reimbursement?
Billing Workflow
1.
Providers of all types verify patient insurance eligibility with the health plan, either prior to or during the admission or visit. Medical offices collect and post copays at the visit.
2.
The patient is treated and discharged or checked out.
3.
As you learned in
Chapter 9
, the provider usually needs to bill a third party, the insurance plan, in order to receive payment. The insurance bill is called a
claim
. The first step in preparing the claim is to assign procedure codes for the services rendered and the supplies used and diagnosis codes representing the disease or medical condition.
4.
Using these codes and the patient registration information, a computer program generates a paper or electronic claim to be sent to the insurance plan.Before the claim is sent to the insurance plan, an insurance or claim specialist reviews the claim to make sure there are no errors. Because of the volume of claims, a computer program is used to examine the claim data and identify problems. Once the claim is correct, it is sent to the insurance plan (usually electronically).
5.
When the claim is received by the insurance plan, it is adjudicated. If the claim is correct, a payment is sent to the provider; this is called the
remittance
. A paper or electronic document is generated that explains the amounts that were paid. This is called the
remittance advice
or
explanation of benefits
(EOB).
6.
When the remittance is received by the provider, the payment amount is recorded in the patient accounts system. Frequently, the amount billed does not equal the amount paid. This may be the result of a contractual agreement that stipulates that the provider will accept a discounted payment and/or that a portion of the charges is the patient’s obligation. An accounting entry called a
write-down adjustment
is posted to adjust the charge.
7.
If the patient has a secondary insurance plan, a claim is next sent to the second plan. In certain cases the first plan will automatically forward the claim to the second plan. This is called a “piggyback” claim or
coordination of benefit
(COB) claim. For example, when a Medicare patient has a supplemental insurance policy with the fiscal intermediary who processes the Medicare claims, the company will sometimes process the secondary claim automatically. This eliminates the need for the provider to file a second claim. These are also known as crossover claims.
8.
Most health plans require the patient to pay a portion of the medical bill. These payments are referred to as the copay, coinsurance, and deductible amou ...
Summary description of an existing system that prevents doctor shopping. Patient prescription patterns are checked for the doctor before writing a new prescription. For the pharmacist, the claim is matched against valid prescriptions, and the filling of similar prescriptions are checked before drugs are dispensed.
Describes a joint CMS/WellPoint voluntary project that demonstrates the effectiveness of Castlestone's VisitEye in preventing many forms of outpatient insurance fraud, in this case Durable Medical Equipment (DME)
Running head Medical Biller Research Paper .docxglendar3
Running head: Medical Biller Research Paper
1
Medical Biller Research Paper
2Medical Biller Research PaperLindsay Williams
Liberty University
2/13/2020Medical Biller Research Paper
The medical biller are healthcare professionals who translate healthcare service to medical claims. The medical billers assess the healthcare services given to a patient and submit claims to the insurance companies and healthcare players such as Medicaid and Medicare. This position is very essential for the financial cycles of the health care providers form a single provider operation to large healthcare facilities. Thus, to be a medical biller, one needs to have basic knowledge in financial analysis and health operation. This knowledge should be accompanied by high level of analysis and combining concepts. In this case, the paper will analyze five topics that are essential for research billers. These topics include; the experience and Qualifications for Insurance Claim Processors, job Functions of a Medical Insurance Processor. Workers compensation, submitting claim electronically and common mistakes resulting claim denials will be also analyzed.
The Insurance Claim Processor or the claim examiners are healthcare insurance employees who assess the medical claim to decide whether an insurance company will pay the claims. The claim examiner job has no specific educational qualification. Though many organizations require one to have a minimum of high school college diploma depending on the organization working policy. Most of the organizations offer in job training, though they recommend the applicant to have knowledge in the related field. For this course, various vocational training schools offers various courses related to this field. (Alyson, 2020). In this role, its highly recommend for candidate to take certified medical reimbursement specialists’ exam. Thus, since there no experience required during hiring of Insurance Claim processors, organizations should provide orientation and on-job training. The Insurance Claim Processor should have good communication skills. The claim examiners should be able to communicate effectively both in writing and verbally. These skills enable them to understand the claim reports, for analysis. The claim examiners should able to communicate feedback clearly to the victim both in writing and verbally. The claim examiners should have good customer service skills such as patience, self-control, critical and logical thinking to help the associate well with clients.
Medical Insurance Processor analyses the validity of medical claims, in the insurance companies to determine whether they are viable for payment. The Medical claims processor managers all the insurance claims from the doctors’ offices. Theprimary role of the Medical Insurance Process evaluates the claims presented in the insurance companies. They have number of responsibilities that revolve ar.
Running head Medical Biller Research Paper .docxjeanettehully
Running head: Medical Biller Research Paper
1
Medical Biller Research Paper
2Medical Biller Research PaperLindsay Williams
Liberty University
2/13/2020Medical Biller Research Paper
The medical biller are healthcare professionals who translate healthcare service to medical claims. The medical billers assess the healthcare services given to a patient and submit claims to the insurance companies and healthcare players such as Medicaid and Medicare. This position is very essential for the financial cycles of the health care providers form a single provider operation to large healthcare facilities. Thus, to be a medical biller, one needs to have basic knowledge in financial analysis and health operation. This knowledge should be accompanied by high level of analysis and combining concepts. In this case, the paper will analyze five topics that are essential for research billers. These topics include; the experience and Qualifications for Insurance Claim Processors, job Functions of a Medical Insurance Processor. Workers compensation, submitting claim electronically and common mistakes resulting claim denials will be also analyzed.
The Insurance Claim Processor or the claim examiners are healthcare insurance employees who assess the medical claim to decide whether an insurance company will pay the claims. The claim examiner job has no specific educational qualification. Though many organizations require one to have a minimum of high school college diploma depending on the organization working policy. Most of the organizations offer in job training, though they recommend the applicant to have knowledge in the related field. For this course, various vocational training schools offers various courses related to this field. (Alyson, 2020). In this role, its highly recommend for candidate to take certified medical reimbursement specialists’ exam. Thus, since there no experience required during hiring of Insurance Claim processors, organizations should provide orientation and on-job training. The Insurance Claim Processor should have good communication skills. The claim examiners should be able to communicate effectively both in writing and verbally. These skills enable them to understand the claim reports, for analysis. The claim examiners should able to communicate feedback clearly to the victim both in writing and verbally. The claim examiners should have good customer service skills such as patience, self-control, critical and logical thinking to help the associate well with clients.
Medical Insurance Processor analyses the validity of medical claims, in the insurance companies to determine whether they are viable for payment. The Medical claims processor managers all the insurance claims from the doctors’ offices. Theprimary role of the Medical Insurance Process evaluates the claims presented in the insurance companies. They have number of responsibilities that revolve ar ...
Running head Medical Biller Research Paper .docxtodd581
Running head: Medical Biller Research Paper
1
Medical Biller Research Paper
2Medical Biller Research PaperLindsay Williams
Liberty University
2/13/2020Medical Biller Research Paper
The medical biller are healthcare professionals who translate healthcare service to medical claims. The medical billers assess the healthcare services given to a patient and submit claims to the insurance companies and healthcare players such as Medicaid and Medicare. This position is very essential for the financial cycles of the health care providers form a single provider operation to large healthcare facilities. Thus, to be a medical biller, one needs to have basic knowledge in financial analysis and health operation. This knowledge should be accompanied by high level of analysis and combining concepts. In this case, the paper will analyze five topics that are essential for research billers. These topics include; the experience and Qualifications for Insurance Claim Processors, job Functions of a Medical Insurance Processor. Workers compensation, submitting claim electronically and common mistakes resulting claim denials will be also analyzed.
The Insurance Claim Processor or the claim examiners are healthcare insurance employees who assess the medical claim to decide whether an insurance company will pay the claims. The claim examiner job has no specific educational qualification. Though many organizations require one to have a minimum of high school college diploma depending on the organization working policy. Most of the organizations offer in job training, though they recommend the applicant to have knowledge in the related field. For this course, various vocational training schools offers various courses related to this field. (Alyson, 2020). In this role, its highly recommend for candidate to take certified medical reimbursement specialists’ exam. Thus, since there no experience required during hiring of Insurance Claim processors, organizations should provide orientation and on-job training. The Insurance Claim Processor should have good communication skills. The claim examiners should be able to communicate effectively both in writing and verbally. These skills enable them to understand the claim reports, for analysis. The claim examiners should able to communicate feedback clearly to the victim both in writing and verbally. The claim examiners should have good customer service skills such as patience, self-control, critical and logical thinking to help the associate well with clients.
Medical Insurance Processor analyses the validity of medical claims, in the insurance companies to determine whether they are viable for payment. The Medical claims processor managers all the insurance claims from the doctors’ offices. Theprimary role of the Medical Insurance Process evaluates the claims presented in the insurance companies. They have number of responsibilities that revolve ar.
Dan Wellisch gave this presentation to the Chicago Technology For Vaue Based Healthcare Meetup at https://www.meetup.com/Chicago-Technology-For-Value-Based-Healthcare-Meetup/
Billing Workflow · 1. Providers of all types verify patient insu.docxAASTHA76
Billing Workflow
· 1. Providers of all types verify patient insurance eligibility with the health plan, either prior to or during the admission or visit. Medical offices collect and post copays at the visit.
· 2. The patient is treated and discharged or checked out.
· 3. As you learned in Chapter 9, the provider usually needs to bill a third party, the insurance plan, in order to receive payment. The insurance bill is called a claim. The first step in preparing the claim is to assign procedure codes for the services rendered and the supplies used and diagnosis codes representing the disease or medical condition.
· 4. Using these codes and the patient registration information, a computer program generates a paper or electronic claim to be sent to the insurance plan. Before the claim is sent to the insurance plan, an insurance or claim specialist reviews the claim to make sure there are no errors. Because of the volume of claims, a computer program is used to examine the claim data and identify problems. Once the claim is correct, it is sent to the insurance plan (usually electronically).
· 5. When the claim is received by the insurance plan, it is adjudicated. If the claim is correct, a payment is sent to the provider; this is called the remittance. A paper or electronic document is generated that explains the amounts that were paid. This is called the remittance advice or explanation of benefits (EOB).
· 6. When the remittance is received by the provider, the payment amount is recorded in the patient accounts system. Frequently, the amount billed does not equal the amount paid. This may be the result of a contractual agreement that stipulates that the provider will accept a discounted payment and/or that a portion of the charges is the patient’s obligation. An accounting entry called a write-down adjustment is posted to adjust the charge.
· 7. If the patient has a secondary insurance plan, a claim is next sent to the second plan. In certain cases the first plan will automatically forward the claim to the second plan. This is called a “piggyback” claim or coordination of benefit (COB) claim. For example, when a Medicare patient has a supplemental insurance policy with the fiscal intermediary who processes the Medicare claims, the company will sometimes process the secondary claim automatically. This eliminates the need for the provider to file a second claim. These are also known as crossover claims.
· 8. Most health plans require the patient to pay a portion of the medical bill. These payments are referred to as the copay, coinsurance, and deductible amounts. The copay amount is usually stated on the patient’s insurance card and collected during the patient visit. The coinsurance amount is usually a percentage of the allowed amount and is not known until the claim has been adjudicated. The EOB tells the provider what amount is the patient’s responsibility. When all the patient’s insurance plans have responded with remittance advice, a ...
There are three main strategies for billing: becoming credentialed as a provider, obtaining preauthorization before submission, and submitting the claim without prior authorization. If a pharmacist is credentialed with the insurance carrier, he or she is already authorized to submit claims to the insurance company for those patients using the pharmacist’s program.
Searching for reliable medical billing and insurance credentialing services in [Insert location or service area]? Look no further! Our expert team offers top-notch solutions to streamline your billing and credentialing processes. Leave the administrative hassle to us and focus on providing excellent patient care.
Mastering Ambulatory Surgery Center Billing_ Essential Guidelines for Success...Cosentus
In this article, we’ll cover everything you need to know about ambulatory surgery center billing and what makes it so complex. We’ll also look at some of the issues that arise around the billing process, as well as some industry best practices and ambulatory surgery center billing guidelines you can adopt to ensure your business doesn’t face any hiccups on account of ambulatory surgery center billing.
How to improve the Claims Adjudication Process?DataGenix
Most use traditional claims management systems that aren't only inappropriate as well as an expensive option for managing complex multi-source data but also complicate the communication between the payers and providers. That's why Claims Adjudication Software is gaining so much consideration.
4 thoughts on conducting successful rcm auditango mark
Conducting regular RCM audits is the only way to ensure your medical practice is getting reimbursed to its fullest potential and is in compliance with evovng regulations. This infographic illustrates healthcare expert Karen Bowden's tips of conducting RCM audits - goo.gl/hrtv7A
Befuddled by MACRA? This infographic shines a light on MACRA facts, important information and expert quotes. Learn more about MACRA with this simple infographic - https://goo.gl/6Ozau4
The healthcare space is evolving constantly The tilt is on technology enabled workflow and revenue cycle solutions. This infographic illustrates the top 9 trends as revealed by Black Book - https://goo.gl/i8uEno
6 revenue cycle metrics you must be tracking nowango mark
Learn how you can improve the financial performance year on year. Leverage your practice revenue cycle metrics by setting benchmarks & KPIs for your billing department - http://bit.ly/2hwlqpm
Prepare your medical practice for cms auditsango mark
Attesting for Meaningful use is just one small piece of the puzzle.Maintaining precise documentation and offering evidence based care can insulate medical practices against MU penalties.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Top 8 Denial Reasons
Action that is taken by
Classification Description the Medical Billing Star
In most cases the claims sent out to local insurance companies
by paper are the ones that need to be resubmitted as the
Claim not on file Insurance companies do not have the initial claims that are
sent. billing office ensures that all unpaid claims are called and Medical Billing Star already follows up on these
(Medical Billing Star checked with the respective insurance companies within their claims and ensures that the claims are resent
responsibility) filing limits. within the filing limits
The billing office ensures that the primary
Additional Information insurance companies EOB is sent out to the
Insurance companies require separate documentation like, secondary Insurance company. All other
(Provider/Patient Primary insurance company’s explanation of benefits, the requests for further information is forwarded to
2 responsibility) coordination of benefits from the patient, accident details etc . the Patients by statements
Patient responsibility This is normally the case when patient is billed for the Medical Billing Star ensures that all payment
payments as they lack an insurance plan and these claims are statements are sent across to the patients in a
3 (Patient responsibility) kept open until we receive payments from the patients timely manner
Medical Billing Star ensures that all payment
statements are sent across to the patients with
Patient not valid This is normally the case when the patient has a insurance an explanation that their plan has been
plan which has termed before his date of service and so the terminated and that they would have to get back
4 (Provider responsibility) payment statement is sent out to the patient for payment with valid insurance information
The provider for certain procedures gets an approval or
authorization number from the insurance company before they Medical Billing Star gets back to the provider for
go ahead. In most cases the authorization number is not information about the authorization number that
No Authorization/Referral# mentioned by the provider’s office in the documents sent over they should have received. If they get the
to the billing office. Insurance companies deny claims for these required info, the claim is resubmitted to the
5 (Provider responsibility) certain procedures on these grounds Insurance company
3. Top Reasons …
Insurance companies have an approved list of
procedure/diagnosis combinations that they would pay Medical billing star already follows up on the
Invalid CPT code/ Dx for. Medical billing star maintains a database of the these claims and ensures that CPT/ICD
code approved combinations by different insurance codes are corrected as per the respective
companies. Our experienced coders ensure that the insurance companies and resubmitted within
(Medicalbillingstar highest paying approved combination of procedure and the filing limits
responsibility) diagnosis codes are used to ensure maximum payment
Mutually Inclusive Modifiers are required for certain claims to be able to tell Medicalbillingstar already follows up on
the insurance company that the procedure billed for is a these claims and ensures that the necessary
revaluation based on a previously billed procedure code. modifiers are included and the claim is
(Medicalbillingstar These are reworked by the billing offices and resubmitted within the filing limits
responsibility) resubmitted within the filing limits
Medicalbillingstar ensures that all payment
Services not covered
This is when the patients insurance does not cover the statements are sent across to the patients
(Patient/Insurance procedure performed by the doctor and in most cases with an explanation that the services that
company’s the payment statement is sent out to the Patient were charged to the insurance company are
responsibility) not covered for their plan
4. Over a 5 month period with our existing clients.
Sl No Categories # of issues Charged amount Amount Received
1 Claim not on file 205 14284.8 5713.9
2 Invalid CPT code/ Dx code 17 4196.8 1678.7
3 Mutually Inclusive 16 1229.3 491.7
4 Additional Information 200 24614.3 9845.7
5 Patient responsibility 96 10438.7 4175.5
6 Services not covered 36 9610.9 3844.3
7 Patient not valid 61 3054.9 1222.0
8 No Authorization/Referral# 49 6407.3 2562.9
680 73837.0 29534.8
*approximate values, based on 40% of the charged values
5. Denial Reasons - # of issues
49, 7%
61, 9%
205, 31%
36, 5%
96, 14%
17, 3%
16, 2%
200, 29%
Claim not on file Invalid CPT code/ Dx code Mutually Inclusive Additional Information
Patient responsibility Services not covered Patient not valid No Authorization/Referral#
6. Denial Reasons – Amount Received
2562.9, 9%
5713.9, 19%
1222.0, 4%
3844.3, 13%
1678.7, 6%
491.7, 2%
4175.5, 14%
9845.7, 33%
Claim not on file Invalid CPT code/ Dx code Mutually Inclusive Additional Information
Patient responsibility Services not covered Patient not valid No Authorization/Referral#
7. Medicalbillingstar also maintains an internal database of rejected
and underpaid claims of various carriers to serve as an expeditious
source of reference for similar cases in the future. This drastically
cuts down our denial management time-frame and puts the money
where the mouth is, i.e. the physician’s pockets