Medical Accounts Receivables

-Maintaining accounts receivable aging reports and constantly review and resolve past due, credit, and debit

My career that I am researching for my junior project is Medical Coding and Billing. Medical Coding and Billing are two different jobs. Medical Coding is when a patient has any medical procedure or exam such as going to the doctor for the stomach virus or even going to the hospital for a broken bone. They work with the insurance companies by putting a specific number into the computer. There’s CPT Codes which stands for Current Procedural Terminology which is “ Codes to better understand the services their doctor provided, to double check their bills or negotiate lower pricing for their healthcare services. (About Health, 2014).”

In order to confirm the accounts receivable balances, I decided to use positive confirmations since this was my first time auditing the company and the collateral for the loan would be the receivables. The confirmations helped to verify the accuracy and existence of the accounts. I also calculated the Receivables Turnover Ratio in order to better evaluate the overall success of collection on accounts. The sample size that I chose was determined by the factors of tolerable misstatement, inherent risk, control risk, achieved detection risk

Molly needs to gather information why these accounts are discharged and they are not billed yet. Some of the possible reasons why bills sat there for so long after patient are discharged include the following;

The process for medical billing involves a health care provider submitting, and following up on claims with health insurance companies in order to receive payment for services rendered; such as treatments and investigations. Once the procedure and diagnosis codes are determined, the medical biller will transmit the claim to the insurance company. Most physicians have medical directors that review claims for patient eligibility. Physician reimbursement and the coding to support it are critically important to the sustained health of any physicians practice. Under the contract provisions the physicians are responsible for rendering the services to the patients. In the billing process physicians need to know how services are rendered.

The billing for services not rendered for are often done as a way of billing Medicare for things or services, that basically never occurred. This can involve forging the signature of those enrolled in Medicare or Medicaid, and the use of bribes or as Healthcare calls it, kickbacks to corrupt healthcare professionals. Upcoding of services is the act of billing Medicare programs for services that are more costly than the actual procedure that was done. Upcoding of items is also very similar to upcoding of services, but it involves the use of medical equipment. For example, billing Medicare for a highly sophisticated and expensive wheelchair, while only giving the patient a manual wheelchair is upcoding of items. Duplicating claims occur when a provider does not submit exactly the same bill, but alters small things such as the date in order to charge Medicare twice for the same service rendered. Therefore rather than a single claim being filed twice, the same service is billed two times in an attempt to receive payments from the government twice. Unbundling involves bills for particular services are submitted as fragmentary, which appear to be staggered out over time. Although, these services would normally cost less when bundled together, but by manipulating the claim, a higher charge is billed to Medicare resulting in a higher pay out to the party committing the healthcare fraud. Excessive services occur when Medicare is billed for something greater than what the level of

In order to insure each staff member was obtaining their individual and team goals, each member was given their own business (Souza). The tools in which the PFS were given provided them with the tools to prioritize and automate account work lists, sort accounts in various ways and see at a glance their ranking with their work group and office-wide. Managers were given their own dashboard and tools which able them to use query all aspects of receivables for trending purposes and identify problem areas, drill down to the patient account level, monitor revenue, payments, adjustments, receivables, and days for periods from the previous day and week to the previous 18 months, calculate average daily revenue by day and 30-day period, assess their performance for the month to date, and estimate likely results at the month end, view all receivables or select any segment for quick analysis, and generate timely reports on demand, including aging analysis, A/R stratification, discharged not final billed (DNFB) analysis, credit balance analysis, and analysis of problem payers. Finally, a denials management component was implemented in late summer, which will allow registration staff to go online at the end of the year (Souza).

The days receivables calculation involves computing net receivables divided by net credit revenues/365. Patton Fuller hospital, for the year 2009, had a net receivables amount of 59,787, this amount can be divided by the net credit revenue (459,900) also divided by 365. The calculation is determined by the formula:

Medical coders, are always working side by side with medical billers and although many people confuse these professions as the same thing, medical coders and billers have different responsibilities individually. It’s a good idea to get your medical coding certification not only because most jobs now a days require some type of schooling, but its also a good idea because it shows the company that you are someone that could fit in just fine. Certifications also shows that you are proficient in your area and are committed to quality healthcare by disseminating quality information, it’s one of the first qualifications that employers look for when they review you as a potential candidate, and it’s an asset when you’re negotiating a salary. In addition, the majority of billing companies have contracts with their clients that obligate

Accounts receivable are amounts owed by customers on account. They result from the sale of goods and services on credit. These receivables are generally expected to be collected within 30 to 60 days. They are typically the most significant type of claim held by a company. Accounts receivable and notes receivable resulting from sales are also known as trade receivables. Accounts receivable resulting from sales are referred to as trade receivables in Alcatel's financial statements.

Balance billing is when the physician was able to bill the patient for any additional balance that was left over after Medicare paid. In order, for this to happen the patient needed to pay the full co-payment the doctor wanted and then submit a form to Medicare to reimburse them the amount they would have paid. This increases the financial risk with a Medicare patient because most Medicare patients can’t afford to lay out the full price of the co-payment right then and their, so they don’t pay their doctor bills. By not paying their doctor bills, they are gaining more debt in their life. Also the patients that can lay out the money can forget to submit the form and don’t receive their reimbursement. By doctors using balance billing, it can

Medical field is one of the biggest fields. When I mention the word medical, the first thing come up to your mind are doctors or nurses. Some people that never work in a medical office, they don't know there are much more position in medical file you could work at, like medical assistant, technician medical coder or biller. Someone like me, don't like to deal with patient. Medical biller and coder is a good opportunity for me to work at. But what are medical biller and coder?

Thanks for considering Reliance Medical Management for your medical billing and management needs. I really appreciate your courtesy and time in considering our services and I know that my company can help your office with its desired needs, even if we both must go back to the drawing board or assist you in finding another route to take. I understand it's hard to know who to turn to and trust.

11. Accounts receivable turnover and days sales in accounts receivable for the last three years:

Accounts receivable turnover is the second method by which a company’s trade receivables’ liquidity can be evaluated (Gibson, 2011). Žager et al. (2012) noted turnover ratios should be as high as possible as this indicates a firm’s ability to convert its assets more often. 3M’s accounts receivable turnover for years 2007 and 2008 is shown in Exhibit 2. In 2007, 3M turned its accounts receivable over 7.12 times and 7.70 times in 2008. This calculates into a turnover of its accounts receivable every 51.28 days in 2007 and 47.38 days in 2008. The increase in accounts receivable turnover times per year (decrease in number of days to turnover accounts receivables) from 2007 to 2008 is a positive trend for 3M. It suggests, along with the prior calculation, the management of receivables is likely to be improving in efficiency.