The document discusses key aspects of the revenue cycle for hospital and physician billing. It covers common billing acronyms and forms, the steps in the revenue cycle including scheduling, registration, charge capture, billing, follow up, and common denials. It provides explanations of registration, coding, billing edits, payment calculations, claim submission and the collection process.
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
Payment posting in RCM seems like an afterthought, something that happens after the “real” work of medical billing ends. After all, you’ve done the hard part and got the payments in the door. Payment Posting is the crucial step in the Revenue Cycle Management process.
Basic Steps to Start Process
1. Infrastructure………………………………………….
2. Medical Billing Software……………………………..
3. EDI Enrollment……………………………………….
4. Requirement from Provider End……………………...
5. Data Migration Procedure…………………………….
6. India-US roles………………………………………….
7. India Operation Set up Flow Chart…………………….
8. Data Transmission/ Work Execution Flow Chart……
This process is complicated and depends on rules that are specific to payers and to the states in which a provider is located. Effectively, a claims appeal is the process by which a provider attempts to secure the proper reimbursement for their services.
Trans-quest is a Healthcare Solutions provider..with a key focus on Revenue Cycle Management services for Physician Groups with a special emphasis on AR & Denial Management. Besides, Trans-quest has medical transcription capabilities and have been servicing various Group Physicians ranging from Multi Specialty, Cardiology, Endocrinology, Neurology, Ophthalmology, Oncology etc.
Revenue cycle management (RCM) is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance.
We provide personal one on one billing services for your office and save you big $$$. Vocis has extensive experience in providing comprehensive billing services for just about every specialty. We provide end-to-end medical billing services, including following-up of pending claims, initiating collections, finding out reasons for denials of claims, and tracking outstanding receivable balances. With a relentless commitment towards providing high quality and cost effective billing and coding services to health care providers around the nation, VOCIS promises a higher level of service and value, as compared to any of our competition.
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/
Medical necessity (CO 50) will be important denial if your DX is not matching with LCD policy. Know the basic of this denial to improve your medical billing
Understanding Patients Eligibility, Copays, Co-Insurance, Past Due Balances 2...Conference Panel
To know more visit, https://conferencepanel.com/conference/understanding-patient-s-eligibility-copays-co-insurance-deductibles-and-past-due-balances-2023-changes
Insurance changes are upon us with January 1st right around the corner. Now is the time to review your internal processes and be sure your team is ready for the upcoming changes and prepare if not!
Every healthcare practice must verify coverage before services, especially in the new year. If needed, we can implement new protocols within your office to be more proactive about patient copays, co-insurance, deductibles, and even patient past-due balances.
Our speaker will give real-world examples of processes successfully implemented at busy practices across the country! Common errors, top training tips, and a detailed checklist for eligibility verification will be covered in depth.
Be sure to attend this MUST SEE webinar, it will bring your practice revenue improvement tools for the upcoming 2023 year!
Payment posting in RCM seems like an afterthought, something that happens after the “real” work of medical billing ends. After all, you’ve done the hard part and got the payments in the door. Payment Posting is the crucial step in the Revenue Cycle Management process.
Basic Steps to Start Process
1. Infrastructure………………………………………….
2. Medical Billing Software……………………………..
3. EDI Enrollment……………………………………….
4. Requirement from Provider End……………………...
5. Data Migration Procedure…………………………….
6. India-US roles………………………………………….
7. India Operation Set up Flow Chart…………………….
8. Data Transmission/ Work Execution Flow Chart……
This process is complicated and depends on rules that are specific to payers and to the states in which a provider is located. Effectively, a claims appeal is the process by which a provider attempts to secure the proper reimbursement for their services.
Trans-quest is a Healthcare Solutions provider..with a key focus on Revenue Cycle Management services for Physician Groups with a special emphasis on AR & Denial Management. Besides, Trans-quest has medical transcription capabilities and have been servicing various Group Physicians ranging from Multi Specialty, Cardiology, Endocrinology, Neurology, Ophthalmology, Oncology etc.
Revenue cycle management (RCM) is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance.
We provide personal one on one billing services for your office and save you big $$$. Vocis has extensive experience in providing comprehensive billing services for just about every specialty. We provide end-to-end medical billing services, including following-up of pending claims, initiating collections, finding out reasons for denials of claims, and tracking outstanding receivable balances. With a relentless commitment towards providing high quality and cost effective billing and coding services to health care providers around the nation, VOCIS promises a higher level of service and value, as compared to any of our competition.
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/
Medical necessity (CO 50) will be important denial if your DX is not matching with LCD policy. Know the basic of this denial to improve your medical billing
Understanding Patients Eligibility, Copays, Co-Insurance, Past Due Balances 2...Conference Panel
To know more visit, https://conferencepanel.com/conference/understanding-patient-s-eligibility-copays-co-insurance-deductibles-and-past-due-balances-2023-changes
Insurance changes are upon us with January 1st right around the corner. Now is the time to review your internal processes and be sure your team is ready for the upcoming changes and prepare if not!
Every healthcare practice must verify coverage before services, especially in the new year. If needed, we can implement new protocols within your office to be more proactive about patient copays, co-insurance, deductibles, and even patient past-due balances.
Our speaker will give real-world examples of processes successfully implemented at busy practices across the country! Common errors, top training tips, and a detailed checklist for eligibility verification will be covered in depth.
Be sure to attend this MUST SEE webinar, it will bring your practice revenue improvement tools for the upcoming 2023 year!
Insurance denials are unfortunately always going to be present in any medical practice. If not handled properly they can quickly overwhelm and take over even the strongest billing team. Insurance payers are constantly adding new ways to reject claims and postpone payments.
Our speaker will cover the top 10 denials seen in 2022 and how to create and implement processes internally to prevent them in the future.
Financial agreements, and their importance, will be covered as well. Do not miss this broadcast of very crucial information. Let our experts help you and your staff identify problems, create lasting results, and watch your revenue rise.
Our speaker will take a deep dive into the details of the type of claim rejections in detail, the top reasons for these denials, and most importantly how to implement internal processes to train staff, improve communication between departments and ultimately improve days in AR and naturally revenue.
Inus has grown from strength to strength in establishing as a Prominent Billing Partner for Respiratory Therapist's, Sleep Medicine Providers and various other DME/HME providers. Lose no time to know how we did @ "Your DME / HME Partner"
Billing Basics for Mental Health Professionals (1 CE Credit)Procentive
Practicing psychologist Richard Sethre, Psy.D., L.P. and Marjie Brinkman, Director of BillCare, combine real world experience and industry knowledge for an informative and practical presentation outlining key billing concepts and issues. They will help you understand how claims are created by billing services, how claims are processed by insurance companies, and how you should respond when there are problems like denials or other payment issues.
Unless you stay current on billing issues and love doing it, this webinar will help you… a busy professional who provides great care but also knows that getting paid for it is pretty important.
Watch the presentation & get continuing education credits here. https://procentive.com/billing-basics/
ASC Reimbursement Guide- Simplified For Ambulatory Surgical Centers.pdfCharlieRobinson32
Ambulatory billing is an essential component of any outpatient medical facility. It entails filing insurance claims and receiving reimbursements for procedures or services performed in the ASC or doctor’s office. Several procedures are involved in adequately submitting claims for ambulatory billing, so that the process can be confusing and time-consuming.
ASC Reimbursement Guide- Simplified For Ambulatory Surgical Centers.pptxCharlieRobinson32
Ambulatory billing is an essential component of any outpatient medical facility. It entails filing insurance claims and receiving reimbursements for procedures or services performed in the ASC or doctor’s office. Several procedures are involved in adequately submitting claims for ambulatory billing, so that the process can be confusing and time-consuming. It is critical to ensure that all claims are accurate and include all required information to avoid delays in receiving payment.
As Operational Site Visits (OSVs) resume virtually, it is important for Community Health Centers to maintain continuous compliance. Compliatric is excited to continue their “Compliance Webinar Series” where each month, program requirements are reviewed to assist health centers in understanding various elements. Participants will be able to utilize these webinars to increase their knowledge of the requirements, and also take compliance to the next level.
This month’s webinar will focus on the following chapter:
Chapter 16: Billing and Collections
Webinar attendee takeaways will include:
· Understanding the requirements and why they are important
· Methods to maintain continuous compliance (without addressing it last minute or only during an OSV)
· How to use the requirement in everyday practice to improve your Community Health Center
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.
Prior to, during, and following a patient visit, accurate documentation is essential for orthopedic billing. All services must be meticulously documented and charged for by the billing staff. A claim could be rejected as a result of mistakes like as inadequate patient demographics entry or failing to confirm the patient’s eligibility in advance. Lack of knowledge of insurer preferences and timeframes might hinder revenue collection, along with authorization errors. In comparison to other specialties, orthopedic billing is challenging and necessitates a deeper comprehension of providers’ offerings.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
1. a Beverly Brouse Creation
Revenue Cycle
Hospital and Physician Based
2. Key Billing Acronyms a Beverly Brouse Creation
UB92 - Uniformed Billing Form (hospital)
•
HCFA 1500 - Physician Billing Form
•
CDM - Charge Description Master
•
CSA - Contractual Service Adjustment
•
DRG - Diagnostic Related Group (IP reimbursement method)
•
ATB - Aged Trail Balance (accounts receivable)
•
EOB - Explanation of Benefits (receive from payor)
•
ICD-9 - International Classification of Diseases (diagnosis)
•
HCPCS - Healthcare Common Procedure Coding System (drugs, devices, supplies)
•
CPT -Current Procedural Terminology (Procedures)
•
HIM - Health information Management (Medical Records Department)
•
HIS - Health information system
•
EMTALA - Emergency Medical Treatment and Liability Act
•
See exhibit A
3. Revenue Cycle a Beverly Brouse Creation
• Scheduling of Appointment (Hospital IP surgery & most OP visits
are scheduled. All Physician visits should be scheduled)
• Pre-Registration Process (Best of practice suggests that at least
90% of scheduled visits should be pre-registered)
• Registration Process
• Charge Capture/Coding Process (Unique between hospital
and physician practices)
• Billing/CSA Posting Process
• Follow-Up Process
See flowcharts A and B
4. Scheduling & Pre-Registration
a Beverly Brouse Creation
• Schedules should be updated regularly for cancellations,
no-shows or rescheduled appointments.
(Daily schedules should be used to reconcile to daily charges).
• Pre-registration occurs prior to the patient’s visit.
• At time of pre-registration, the following should occur:
1. Verification of insurance coverage,
2. Verification of patient demographic information,
3. Identification of self-pay balances (including co-pays and
deductibles), and
4. Obtain needed pre-authorizations
• Information gathered during pre-registration should be
documented in the system.
5. Registration
a Beverly Brouse Creation
• At time of registration, the following should occur:
1. Obtain copies of all insurance cards (primary, secondary &
tertiary coverage).
2. Practice the Birthday Rule when the patient is a child.
3. Request a form of photo ID to verify the patient’s identity (this
will ensure confidentiality of the patient’s medical records).
4. Verify patient demographic information and document this
information in the system (verify against the patient’s ID).
5. Collect all monies due from patient (self-pay balances, co-pays
and deductibles). The use of a day sheet is helpful when
reconciling to daily deposits.
• Registration information documented in system is usually
automatically pulled onto the UB04 and/or HCFA1500.
See exhibit D & E
6. a Beverly Brouse Creation
Registration Continued
• Registration in the ER is regulated and restricted
by EMTALA. See flowchart C
7. a Beverly Brouse Creation
Charge Capture/Coding
• Physician, nurse or physician assistant document all
services rendered to the patient.
• Charges captured in system by clinical departments or on
charge slips/superbills/charge tickets and forwarded for
entry into HIS
• Some CPT codes are hard coded in the CDM along with
the charge
• Medical records/HIM is responsible for the coding of
HCPC and ICD9 codes (soft coded).
• Once captured, codes are usually transferred from coding
system to HIS by means of interfacing.
See flowchart A
8. Claim Edits/CSA
a Beverly Brouse Creation
• Once claim is created, UBs/HCFA1500 are usually sent
through some kind of scrubbing system for editing.
• Errors identified during the editing process are corrected
by billing personnel.
• Prior to claim submission, CSA automatically calculated
by the system and posted to the patient’ s account or
manually posted after receipt of payor remit. (may vary by
payor)
• CSA is based on individual payor and their method of
payment. (based on individual payor contracts)
9. a Beverly Brouse Creation
Methods of Payment Calculations
Payment based on…
• DRG - fees paid based upon diagnosis (pre-defined).
• Per Diem - fees paid based upon the length of the patient’ s stay.
• Percent of Charges - fees paid based on a pre-determined percentage
(outliers are usually also negotiated in the contract)
• Capitation - fees based upon the estimated number of service occurrences
(fixed payment received in advance regardless of number of services
performed).
• Fixed Rate - fees based upon specific procedures performed (pre-defined).
• Fee for Service – fees for charges billed (no discount).
10. a Beverly Brouse Creation
Claim Submission
• Once sent through the scrubbing or editing
process, claims are ready for submission to
insurance carrier (backlogs may occur in clearing edits)
(additional hold time may also occur before submission).
• Most payors require electronic claim submission
• Some secondary payors require hard copies of the
UB04/HCFA1500 along with the primary payor’ s
remit.
11. a Beverly Brouse Creation
Collection Process
• ATBs should run periodically and be used when
following up on outstanding claims (ATBs list claims by
aging category).
• Claims are worked in order of age and dollar
amount (oldest, higher dollar claims are worked first).
• Productivity tracking should exist to monitor the
efficiency of follow-up.
• Follow-up personnel will also use EOBs as a tool
to work outstanding claims.
Per HIPAA regulations, third party payors must pay or deny a claim
within 30 days of receipt.
12. a Beverly Brouse Creation
Common Denials
The following are samples of possible denials
by insurance carriers:
• Patient Not Covered - this is a registration weakness.
• Untimely Filing - claim was received past the filing limit (this is
typically a billing weakness).
• Invalid ID Number - this is a registration weakness.
• No Authorization on File - this is a pre-registration weakness.
• Other Insurance Primary - this is a registration weakness.
• Pre-Existing Condition – could be a registration weakness.
Note: These are just a few of the many denials issued by payors.