Pmg's Dilemma Case Solution

she does not use a supplier that accepts Medicare assignments she will have to pay the entire

Provide full antenatal care including the screening tests in the hospital, community and at home.

7. A full-term baby girl was born at a local community hospital on 07/08, at which time the infant's APGAR scores were 9 and 10 and the normal infant was examined prior to her admission to the nursery. On the second day of admission (07/09), the normal newborn was discharged home with her mother. Code the discharge.

Step 6 - Generate patient statements - This will be the final process by letting the patient know what the balance most of the time should be 0 if services were covered and co-pay was paid prior. There is other instances when insurance providers will decide not to cover and the patient will then end up with the balance left over.

Maternity Care and Delivery is a totally different situation that involves the health and well being of two patients, the mom and the baby. The procedures we code for would include the monitoring

I have read and understand Newfield Family Medical Practices Financial Policy and agree to comply with it. I also agree that if it becomes necessary to forward my account to a collection agency, I will be responsible for the fee’s charged by the collection agency for the cost of the collection of my account.

| Prospective Payment System (PPS) first began in 1980 with a small number of hospitals partitioned into three groups according to their budget positions---breakeven, surplus, and deficit--- prior to the imposition of DRG payment (Diagnosis- related group). The PPS as DRG’s had been designed to limit the share of hospital revenues derived from the Medicare program budget, and in spite of doubtful results in New Jersey, it was decided in 1983 to impose DRG’s on hospitals nationwide.

Most claims today are submitted through an electronic format directly or indirectly through a “clearinghouse” where claims are grouped and sent to the payer. Two primary payment grouping algorithms are DRG’s and APCs, both are used by Medicare for hospital payment and many commercial payers. Providers and payers use claims editing software to detect possible errors in claim submission to assure maximum payment for medical services and to shorten an amount of time from claim submission to payment. CMS has developed the National Correct Coding Initiative (NCCI) to promote national correcting coding methodologies and to control improper coding leading to inappropriate payment (Cleverley 26). CMS also has designated edit checks called the outpatient code edits (OCE). The OCE uses claim-level and line item-level information in the editing process. Each category in the OCE has six dispositions which help to ensure all Fiscal Intermediary/Medicare Administrative Contractor (FI/MACs). The four claim-level is rejection, denial, return to provider, and suspension; and the two-line item-level is rejection and

On 3/29/2017, this writer met with Mary Eckola alongside with Adriana upon request in the event that the patient assigned counselor is not available. During the discussion, it was based on addressing the overpayment of the patient and her significant other. Also, HCRC continues to send the patients medical record to the insurance company, but no payment. Adriana discussed about payment options, referring to an 8 week payment plan for Mary and her significant other as Mary appeared to the receptive the notion of the payment plan. Mary was very forthcoming about paying the entire balance of her balance and her significant other, but wants to be certain that should be pay the balance that there will be no other issue with this matter. According

Since, it take a while to resolve the issue AGP we will override TFO. NICU claims are only reimbursable under the Newborn ID and authorization. However, Well Newborn claims are reimbursable so long as the inpatient stay matches the days covered under the mother’s authorization. The authorizations are provided but they will need to be checked to ensure that they match the service. Once the claims are processed, they will make the provider whole.

I'm FWD to the SFL billing department some colposcopy f/u labs results visits. When I was working with all the colposcopy visits I found that the patient came already for the colpo labs F/U results but alot of the claims was adjusted incorrectly on PM. I review all the claims and I correct all the incorrect adjusments and these are all the patients that I'm billing back to SFL.Hopefull we can get paid all these visits.I spoke with Robin from SFL and she told me what I should to bill back to them for these type of service and I did. ALL the claims been bill out to the program today. I just want to keep you on the loop with this little project.

Gloria Benson has been working for the Jackson State Health Department (JSHD) for about 15 years and has been the Prenatal Presumptive Eligibility (Prenatal PE) manager for about 9 years. Recently the JSHD received additional grant money to expand on the Prenatal PE program by offering new benefits to the people of Jackson. The contract originally outlined that, Presumptive Eligibility gives pregnant women of Jackson, JackCare coverage for sixty-two (62) days to allow time to apply for regular Medicaid through the federally marketplace located on the healthcare.gov website. If no Medicaid application is filed during the Presumptive span of eligibility, then coverage could end. With the expansion the contract outlines that, applications for

I did the Same Beacon Contract with mercy and after that started with Employ Benefit Plan Administration (EBPA) with EMHS I started reading it and found that EBPA is Just looking at the claims and submitted by the Provider it is just acting as Administrator and the actual money is payed by CMS to the provider. I then Prepaid Inventory and updated the rate sheet

If we are unable to verify that the newborn has active coverage within 30 days of the newborn inpatient encounter, the encounter is then changed to self-pay.

The fourth step is the charge entry, this is where the bill is created. An account is set up for every patient with the demographics and the account is assigned a number. While talking to B. Mcleod (personal communication, May 26, 2015) it was also stated that one of the key functions for charge