Ethel Owen - Administrator Arthritis & Rheumatology Associates of Palm Beach, Inc. West Palm Beach, FL
|
|
- Dana McCarthy
- 5 years ago
- Views:
Transcription
1 Ethel Owen - Administrator Arthritis & Rheumatology Associates of Palm Beach, Inc. West Palm Beach, FL
2 Practice Structure Office Management Physician Encounter Billing Office
3 Physicians & Administrator Clinical Managers And Physician Associates Business Personnel Check in, Checkout, In-Fusion, Lab & X-ray Staff MA s RN s Mid-levels Billing Manager Billing Staff Administrative Staff
4 Policies and Procedure Manual Employee Handbook Review protocols regularly with staff. Staff members require constant supervision, and retraining.
5 Assign responsibility Regularly review staff performance Ensure compliance and regulatory standards Establish and maintain an atmosphere conductive to staff cohesion and cooperation Procedures and conflict resolution
6 Team Effort Continuing Education for staff Staff in-services Physician and front office communication Front office and back office communication
7 SCHEDULING CHECK- IN PHYSICIAN ENCOUNTER BUSINESS OFFICE CHECK - OUT
8 First Impression Professionalism Set the expectations Bring outside records Cancelation policy
9 Smile and greet patient Review Patient Information Form (PIF) Pharmacy information Medical Release Patient Check referral status Office Policies Scan insurance card Collect co-payment Photo Enter Demographics
10 Review Demographics at Each Visit Phone Numbers Home Address Verify Insurance Verify Pharmacy Information Collect Outstanding Balances
11 Physician obtains history Examines the patient Enter data in to EHR Orders diagnostic imaging and laboratory tests Calculates disease activity score Assessment and Plan Implements treatment plan
12 Code Diagnosis to Support Medical Necessity ICD-10 Is more than a method to communicate a patients diagnosis to an insurance carrier to receive payment Diagnosis Codes Support Procedures and Orders Reduces Compliance Risk Proper ICD - 10 documentation enables quality patient management and ensures proper reimbursement
13 Charge Capture Office Visit Level In Office Labs Injections Medications Procedures Imaging
14 Verify physician orders Schedule ancillary service in accordance with orders Track services provided in-office and at referral facility Comply with payer requirements for Ancillary Services
15 Review follow-up care with patient Verify insurance information Provide patient with applicable written/printed instructions Review outside referrals, Imaging, PT, Labs Collect deductibles and coinsurance, Schedule follow up visit
16 Managing documentation within practice is vital
17 Monitor coding and documentation compliance with regularly performed internal reviews Utilize services of coding consultants to perform periodic audits Employ outside consultants through legal council so all findings are attorney-client privilege
18 Third-parties may conduct coding audits Practice Management System provide assistance Develop profiles on each physician, Identify coding patterns Analyze reasons for inter-physician variance Analyze in comparison to benchmarks
19 Office Encounter Tests or Imaging Procedures Labs Outsides Orders
20 Tell the story Support medical necessity Excellent Patient Care Claims Payment Keeping your Money Successful Practice
21 Consequences of Up-Coding and Down-Coding Level 5 Level 4 Level 3 Level 2 After Before Level If documentation and coding protocols were in place and adhered to, proper E&M coding for Level 3 and 4 for these two physicians would have resulted in an increased annual reimbursement commensurate with work done.
22
23 Accounts Receivables (A/R) is money owed for services rendered Sources of Revenue Insurance Companies Foundations/Industry Co-Pay Cards Patients Co-pays Coinsurance Deductibles
24 Define roles Cross train Knowledge of contracts and allowables Updated fee schedules Procedures Up to Date bundling edits Knowledge of managed care policies and procedures Effective communication
25 Office Claims Management Process Every step exists to increase the likelihood that each claim is reimbursed Pre-Encounter Admin. Access Management Eligibility Medical Necessity Patient-Doctor Encounter Concurrent Denial Mgmt./ Length of Stay Mgmt. Back-Office Administration Practice Mgmt. System Billing Rejection/ Denial Mgmt. EDI* Referral Authorization Patient Self Registry Utilization Mgmt. Coding A/R Mgmt. Bad Debt. Mgmt. Benefit Authorization Patient Portals & Kiosks Government/ Regulatory Compliance Contract Mgmt. Claims Editing * EDI Electronic Data Interface
26 Conduct daily billing audits Daily claims submission Document proof of timely submission Maintain current fee schedules Reports Track denials by procedure, by department, by doctor Appeals and review
27 Robust Practice Management System Provide Reports Aged Account Balances Income by Location Income by Doctor Rejected Claims Report By Doctor By Location By Procedure
28 Robust system for preparation and submission of claims Ability to load and maintain payer fee schedules Ability to track claims Knowledge of payment terms by payer Ability to code check Modifiers Diagnosis code and procedure mismatch
29 Practice viability under increasing economic pressure: Operating costs increasing; reimbursement declining Revenue needed to replace equipment, hire trained staff, expand services and locations, etc. Ancillary revenue sources under pressure Consumer-directed health plans on the rise to combat employer health costs - more pressure on price Consolidation among insurers giving payers leverage Under Insured Patients
30 Key Objectives Using the right people, tools and processes to maximize cash flow Collect on every procedure Collecting the contracted amount Time Management Claims Management Maintain Accountability Appropriate work loads
31 Education and training Communication Documentation Front office collections Back office billing and collections Customer Service Physician Involvement
32 Questions?
33 Thank You for Your Participation!
Effective Billing and Collections. Copyright 2017 State Volunteer Mutual Insurance Company
Effective Billing and Collections 1 Copyright 2017 State Volunteer Mutual Insurance Company Changing Environment Shift in responsibility, payment models and adjustments High deductible health plans (HDHP)
More informationAnn Silvia, BS, CPC, CPB, CPC-I, CPMA, CPPM, CANPC, CEMC, CFPC
Ann Silvia, BS, CPC, CPB, CPC-I, CPMA, CPPM, CANPC, CEMC, CFPC This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable
More informationBenchmarking the Revenue Cycle Top 10 Revenue Cycle Best Practice Solutions
Benchmarking the Revenue Cycle Top 10 Revenue Cycle Best Practice Solutions Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky 40223 502.992.3511 sshover@blueandco.com Revenue
More informationINFORMATION ABOUT YOUR OXFORD COVERAGE
OXFORD HEALTH PLANS (CT), INC. INFORMATION ABOUT YOUR OXFORD COVERAGE PART I. REIMBURSEMENT Overview of Provider Reimbursement Methodologies Generally, Oxford pays Network Providers on a fee-for-service
More informationOptimizing Revenue Cycle
Optimizing Revenue Cycle CureMD User Conference 2014 Presented by Kelly J. Langschultz CEO & Founder of Precision Billing & Consulting Services, LLC www.precisionbillinginc.com Optimizing Revenue Cycle
More informationSponsored by: Approved instructor
Sponsored by: Approved About the Speaker Nancy M Enos, FACMPE, CPMA CPC-I, CEMC is an independent consultant with the MGMA Health Care Consulting Group. Mrs. Enos has 40 years of experience in the practice
More informationCMS-1500 professional providers 2017 annual workshop
Serving Hoosier Healthwise, Healthy Indiana Plan CMS-1500 professional providers 2017 annual workshop Reminders and updates The (Anthem) Provider Manual was updated in July 2017. The provider manual is
More informationAetna. CCHCA Physician Handbook (7 th Edition)
Part II Section A Aetna Introduction 1 Verifying Aetna Member Eligibility and Benefits 1 Aetna Sample Member ID Card 2 Aetna Prescription Drug Program 3 Pharmacy Benefit 4 Prior Authorization for Medications
More informationProvider Orientation. style. Click to edit Master subtitle style. December, 2017
Click EMHS to Employee edit Master Health title Plan Provider Orientation Click to edit Master subtitle December, 2017 Pam Hageny Director of Health Plan Operations & Provider Network Beacon Health EMHS
More informationWORKERS COMPENSATION REFORMS OFFICIAL MEDICAL FEE SCHEDULE PHYSICIAN SERVICES SUMMARY CHANGES TO THE OFFICIAL MEDICAL FEE SCHEDULE PHYSICIAN SERVICES
SUMMARY CHANGES TO THE SB 863, enacted in 2012, required the Division of Workers Compensation to transition the Official Medical Fee Schedule for physician services to a Medicare RBRVS system over four
More informationManagement: A Guide To Optimizing. Market
Best Practices In Revenue Cycle Management: A Guide To Optimizing Your Revenue Cycle In A Value-Based Market T h e 2 0 1 8 O P E N M I N D S M a n a g e m e n t B e s t P r a c t i c e s I n s t i t u
More informationM e d i c a r e P P S I m p l e m e n t a t i o n : C o n s i d e r a t i o n s f o r F Q H C s
M e d i c a r e P P S I m p l e m e n t a t i o n : C o n s i d e r a t i o n s f o r F Q H C s A g e n d a Overview of the FQHC Medicare reimbursement system New FQHC Medicare Prospective Payment System
More informationBenchmarking the Revenue Cycle Top 10 Revenue Cycle Best Practice Solutions
Benchmarking the Revenue Cycle Top 10 Revenue Cycle Best Practice Solutions Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky 40223 502.992.3511 sshover@blueandco.com Revenue
More informationPatient Billing and Financial Services
Patient Billing and Financial Services UNDERSTANDING YOUR OBLIGATIONS BAYHEALTH.ORG We realize this can be a stressful time for you and your family. We particularly understand how frustrating it can be
More informationD e v e l o p i n g a C o m p e t i t i v e N A P A p p l i c a t i o n : Y o u r B u d g e t a n d F i n a n c i a l M e a s u r e s
D e v e l o p i n g a C o m p e t i t i v e N A P A p p l i c a t i o n : Y o u r B u d g e t a n d F i n a n c i a l M e a s u r e s G O A L S A N D O B J E C T I V E S The goals of this webinar include
More informationThe Front-End Revenue Cycle Specialists. The Dilution of the Dollar
The Front-End Revenue Cycle Specialists The Dilution of the Dollar The Silent Revenue Cycle Killer You are likely losing up to 40 cents on every dollar before you even render any patient services. By the
More informationKey to Higher Reimbursements Reimbursements
Key to Higher Reimbursements Reimbursements CureMD User Conference 2014 Presented by Kelly J. Langschultz CEO & Founder of Precision Billing & Consulting Services, LLC www.precisionbillinginc.com Higher
More informationPartnering with Healthcare for Better Revenue Cycle Results HFRI.NET
Partnering with Healthcare for Better Revenue Cycle Results More Paid Claims. More Cash. Our proven combination of expertise and technology delivers results, improving your bottom line and letting you
More informationCLINICAL RESOURCE GROUP, INC. CHIROPRACTIC ADMINISTRATIVE MANUAL
CLINICAL RESOURCE GROUP, INC. CHIROPRACTIC ADMINISTRATIVE MANUAL UPDATED: 1-1-2012 TABLE OF CONTENTS Chapter One - Provider Services Contact Information Benefit and Summary Verification Communication Resources
More informationUnlocking and Using Practice Performance Intelligence
Unlocking and Using Practice Performance Intelligence Patti Peets, Director, Revenue Cycle Management CareCloud, Miami Patti Peets does not have a financial conflict to report at this time. 1 Learning
More informationEFFECTIVE REVENUE CYCLE MANAGEMENT IN YOUR NETWORK
EFFECTIVE REVENUE CYCLE MANAGEMENT IN YOUR NETWORK 1 INTRODUCTION Revenue Cycle Management has become an even more complex issue with declining reimbursements, implementation of Electronic Health Records,
More informationToday s Payers and Providers
Today s Payers and Providers Strategies for Success Emad Rizk, MD President and Chief Executive Officer Accretive Health Session Objectives Description of value based models in the market Data elements
More informationWhat Regulatory Requirements are Responsible for the Transactions Standards?
Versions 5010 Why the Change? 99% of Medicare Part A and 96% of Part B Claims are submitted electronically New Accreditations standards adopted with Electronic Medical Records must align with the submitted
More informationLightHouse HEALTHCARE POLICY MANUAL
Page 1 of 7 HIPAA Policy No. 4A Minimum Necessary/Need to Know Policy and Procedure Policy: 4.1 Uses and Disclosures restricted to minimum necessary information Except for uses and disclosures related
More informationBudgeting Basics 101
Budgeting Basics 101 The Nuts and Bolts of Budget Planning November 3, 2008 Agenda Understanding Budget Basics What is a Budget? Budget Types: Six Categories Budget Approaches Case Study Components of
More informationDHCFP. Health Safety Net Implementation and Eligibility. A Report by the Executive Office of Health and Human Services
DHCFP Health Safety Net Implementation and Eligibility A Report by the Executive Office of Health and Human Services Division of Health Care Finance and Policy & Office of Medicaid Submitted in compliance
More informationPlease submit claims and encounters electronically via Office Ally at
Claim Submission All claims must be submitted within 90 calendar days from the date of service for contracted providers unless otherwise stated in the provider service agreement. Please submit claims and
More informationProvider Manual. ChoiceBenefits. BayCare Health System Medical Plan
2019 Provider Manual ChoiceBenefits BayCare Health System Medical Plan 1 Table of Contents BayCare... 2 BayCare Exclusive Network... 2 Rules unique to Cigna BayCare Members... 2 Provider Relations Representative...
More informationRegistration FSC/Plans & Invoice FSC
Registration FSC/Plans & Invoice FSC Overview Introduction This lesson introduces you to key terms and structure related to FSC/Plan Assignment. You will learn why an invoice FSC may be different from
More informationEnsuring Payment Certainty in an Uncertain Payment Environment
in an Uncertain Payment Environment An Experian Health White Paper The financial health of provider organizations depends on collecting every dollar due. Efficient processes and automated workflow to assure
More information5 STEPS. to Prevent and Manage Denials. kareo.com
5 STEPS to Prevent and Manage Denials kareo.com Table of Contents STEP 1 Calculate Your Denial Rate 04 STEP 2 Identify Top Denial Reasons 05 STEP 3 Implement Eligibility Verification 06 STEP 4 Improve
More informationZimmer Payer Coverage Approval Process Guide
Zimmer Payer Coverage Approval Process Guide Market Access You ve Got Questions. We ve Got Answers. INSURANCE VERIFICATION PROCESS ELIGIBILITY AND BENEFITS VERIFICATION Understanding and verifying a patient
More informationSurviving The Storm 10/6/2015. Physicians Are Feeling the Pain
Surviving The Storm REMAINING AN INDEPENDENT PHYSICIAN PRACTICE Physicians Are Feeling the Pain Financially Squeezed Decline in reimbursement and loss of income Overhead, malpractice insurance and working
More informationAppeals, Denials and Audits How to Protect Your Hospital. Shirley Barton, President, AMR Debra Harrison, DNP, RN, AMR
Appeals, Denials and Audits How to Protect Your Hospital Shirley Barton, President, AMR Debra Harrison, DNP, RN, AMR Successfully defending and decreasing denials and appeals through education and persistence
More informationBilling and Collections Knowledge Assessment
Billing and Collections Knowledge Assessment Message to the manager who may use this assessment tool: All or portions of the following questions can be used for interviewing/assessing candidates for open
More informationSEQUELMED Glossary. Advance Payment: An amount of money paid by a patient that cannot be applied against a charge at the time the payment was made.
SEQUELMED Glossary Account Number: SequelMed will automatically assign the next unique account number when the user hits the Save button. However, a user can manually assign an account # at the time of
More informationACCOUNTS RECEIVABLE FOLLOW-UP CRITERIA
Patient Balances Argus Billing Office follows the following criteria when dealing with patients balances. Argus Business Office will send five (5) statements; one (1) collection letter and will make one
More informationTOP 10 METRICS TO MAXIMIZE YOUR PRACTICE S REVENUE
TOP 10 METRICS TO MAXIMIZE YOUR PRACTICE S REVENUE Billing and Reimbursement for Physician Offices, Ambulatory Surgery Billings & Reimbursements Here are the Top Ten Metrics. The detailed explanations
More informationFederally Qualified Health Center (FQHC) / Rural Health Clinic (RHC) Prospective Payment System (PPS) Frequently Asked Questions.
Federally Qualified Health Center (FQHC) / Rural Health Clinic (RHC) Prospective Payment System (PPS) Frequently Asked Questions General 1. Is there language in our agreement around updated contracts with
More informationNETWORK PROVIDER REFERENCE MANUAL
NETWORK PROVIDER REFERENCE MANUAL TABLE OF CONTENTS QUICK CONTACT LIST... 3 INTRODUCTION... 4 IMPORTANT DEFINITIONS... 5 NETWORK PARTICIPATION... 9 Responsibilities of Provider Participation... 9 Subcontracts
More informationInformation About Your Oxford Coverage
Information About Your Oxford Coverage Overview of provider reimbursement methodologies Generally, we pay participating providers ("network providers") on a fee-for-service basis. Feefor-service based
More informationBest practices for migrating healthcare payments to ACH
Best practices for migrating healthcare payments to ACH Member FDIC Member FDIC Matt Brodis, MBA, MHA Adventist Health System, Inc. June St. John, SVP, CTP Wells Fargo Treasury Management Member FDIC Healthcare
More informationAdvanced Podiatry. W E A R E V E R Y P L E A S E D T O H A V E Y O U W I T H U S! Please answer the following questions to help us become acquainted.
W E A R E V E R Y P L E A S E D T O H A V E Y O U W I T H U S! Please answer the following questions to help us become acquainted. Date How did you hear about us? (Be Specific Please) First Name Last Name
More informationFinancial Policy Guidelines
Financial Policy Guidelines Welcome to The Women s Group of Northwestern. We strive to provide you with excellent medical care and our goal is to make your visit as convenient as possible. Please read
More informationPractical Strategies for Denials Prevention Across the Revenue Cycle
Practical Strategies for Denials Prevention Across the Revenue Cycle For Discussion Purposes Only 2017 nthrive, Inc. All rights reserved. Today s Speakers Gina Stinson Sr. Director, Process Excellence
More informationFlorida 2016 Legislative Update House Bill 221 & House Bill 1175
Florida 2016 Legislative Update House Bill 221 & House Bill 1175 Tracy Lutz, Esquire, Managing Partner Specialized Healthcare Partners September 16, 2016 House Bill ( HB ) 221- Extends balance billing
More informationPractical Strategies to Improve Laboratory Financial Performance
Slide 2 SML1 Sunrise Medcial Labs, 04/09/2008 Practical Strategies to Improve Laboratory Financial Performance Executive War College 2008 Miami, Florida May 14 th, 2008 Martin Colucci, CFO Sunrise Medical
More informationFrequently Asked Questions
Corrected Claims Submissions 1. What is a corrected claim? If a claim was submitted to and accepted by Healthfirst but was later found to have incorrect information, certain data elements on the claim
More information5 Steps to Reducing Administrative Costs in Physician Group Practices (A05)
5 Steps to Reducing Administrative Costs in Physician Group Practices (A05) Presenters: Kenneth Willman, Director Provider Interface, Humana Melissa Lukowski, Director Outreach, athenahealth Mary Kelley,
More informationBilling and Collections Knowledge Assessment
Billing and Collections Knowledge Assessment Message to the manager who may use this assessment tool: All or portions of the following questions can be used for interviewing/assessing candidates for open
More informationHealthcare Financial Management Association Certification Program. Module I: The Business of Health Care Learner s Guide
Healthcare Financial Management Association Certification Program Module I: The Business of Health Care Learner s Guide For examination period beginning June 2015 1 Course 1 - The Big Picture Learning
More informationMeasure #436: Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques National Quality Strategy Domain: Effective Clinical Care
Measure #436: Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS,
More informationAppeals and Grievances
Provider Appeals The Molina Healthcare of Michigan Appeals team coordinates clinical review for Provider Appeals with Molina Healthcare Medical Directors. All providers have the right to appeal any denial
More informationElectronic Prior Authorization Benchmarking; Dental and Workers Compensation
Electronic Prior Authorization Benchmarking; Dental and Workers Compensation Presented By: Kathy Jönzzon, Delta Dental Sherry Wilson, Jopari Solutions Agenda Overview Prior Authorization Governance Overcoming
More informationThe following questions were received in response to our provider webinars presented by Blue Shield of California s network management teams.
Ancillary Claims Filing Requirements Frequently Asked Questions The following questions were received in response to our provider webinars presented by Blue Shield of California s network management teams.
More information10/10/2012. Goals. The Exciting Future of Practice Management. Practice Management. Practice Management. The Future. Practice Management
Goals The Exciting Future of Practice Management Define practice management Current expectations of practice managers How practice management is changing Finding success as a practice manager Looking to
More informationRULES OF TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT DIVISION OF WORKERS COMPENSATION
RULES OF TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT DIVISION OF WORKERS COMPENSATION CHAPTER 0800-02-06 GENERAL RULES OF THE WORKERS COMPENSATION PROGRAM TABLE OF CONTENTS 0800-02-06-.01 Definitions
More informationYou must pay all of the costs for these services up to the specific deductible amount before this plan begins to pay for these services.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.avmed.org or by calling 1-800-477-8768. Important Questions
More informationPhysical Therapy Facility Application
Physical Therapy Facility Application 1. Name and Mailing Address of Facility: 2. Agent: Contact Person: Phone: Fax: E-Mail: Website: 3. Tax ID: 4. License No. 5. Type of Coverage: Claims-Made Occurrence
More informationSTRIDE sm (HMO) MEDICARE ADVANTAGE Claims
9 Claims Claims General Payment Guidelines An important element in claims filing is the submission of current and accurate codes to reflect the provider s services. HIPAA-AS mandates the following code
More informationInnovation Health At-A-Glance
Innovation Health At-A-Glance A quick reference guide for health care professionals 71.02.801.1 (8/13) innovation-health.com A guide for doing business with Innovation Health Getting started with Innovation
More informationPRO SPORTS THERAPY, INC. (P.S.T.)
PRO SPORTS THERAPY, INC. (P.S.T.) Dear Patient, Thank you for choosing Pro Sports Therapy. Enclosed is the paperwork we need you to complete and bring to your upcoming physical therapy evaluation appointment.
More informationNetwork Facility Handbook
Network Facility Handbook MultiPlan, Inc. 115 Fifth Avenue New York, NY 10003 www.multiplan.com 2017, MultiPlan Inc. All rights reserved. Updated January 3, 2017 Contents Introduction... 3 Important Definitions...
More informationPROVIDER SERVICES Section IV Provider Services
Section IV Provider Services Provider Services 98 NaviNet www.navinet.net Using NaviNet reduces the time spent on paperwork and allows you to focus on more important tasks patient care. NaviNet is a one-stop
More informationEffective Revenue Cycles Are No Accident
Effective Revenue Cycles Are No Accident Physician Leadership Institute March 7,2015 Jerrie K. Weith, MBA, FHFMA, CMPE, CMOM Learning Objectives Characteristics of Best Performers Efficient Encounters
More informationImportant Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.summacare.com or by calling 1-800-996-8701. Important
More informationClaims Administrator Questionnaire
Claims Administrator Questionnaire About PartnerRe PartnerRe is an acknowledged leader in providing risk management solutions to accident and health markets around the world. Our team of experienced professionals
More informationKaiser Foundation Health Plan, Inc. CLAIMS SETTLEMENT PRACTICES PROVIDER DISPUTE RESOLUTION MECHANISMS Northern California Region
Kaiser Foundation Health Plan, Inc. CLAIMS SETTLEMENT PRACTICES PROVIDER DISPUTE RESOLUTION MECHANISMS Northern California Region Kaiser Permanente ( KP ) values its relationship with the contracted community
More informationBeyond Correct Coding: Being Paid for What You Do and Avoiding Billing Blunders
Beyond Correct Coding: Being Paid for What You Do and Avoiding Billing Blunders Presented by Teresa Thompson And Tessie Adams We have nothing to disclose 1 Audit Your Practice? Efficiency s of work flow
More information10 Best Practices For Payer Contracting:
10 Best Practices For Payer Contracting: A Roadmap for Successful Negotiations Steve Selbst Healthcents, Inc. 2016 NHIA Annual Conference & Exposition 1 Speaker Disclosures Steve Selbst is employed by
More information10 Best Practices For Payer Contracting: A Roadmap for Successful Negotiations
10 Best Practices For Payer Contracting: A Roadmap for Successful Negotiations Steve Selbst Healthcents, Inc. Speaker Disclosures Steve Selbst is employed by a business firm that provides services related
More information6/14/2012. Introduction Presentation: Betsy Nicoletti, M.S., CPC Kareo Special Offer: Tadd Dombart, Account Executive, Kareo Questions
Medical Billing Made Easy Presents Stop Denials in Their Tracks: Get Paid the First Time by Health Care Insurers Beginning now www.kareo.com Today s Program Introduction Presentation: Betsy Nicoletti,
More informationBilling Guidelines Manual for Contracted Professional HMO Claims Submission
Billing Guidelines Manual for Contracted Professional HMO Claims Submission The Centers for Medicare and Medicaid Services (CMS) 1500 claim form is the acceptable standard for paper billing of professional
More informationAETNA BETTER HEALTH OF FLORIDA Claims Adjustment Request & Provider Claim Reconsideration Form
Aetna Better Health of Florida 1340 Concord Terrace Sunrise, FL 33323 AETNA BETTER HEALTH OF FLORIDA Claims Adjustment Request & Provider Claim Reconsideration Form Aetna Better Health of Florida is committed
More informationThis Member Health Statement reflects medical and pharmacy claims finalized within the preceding 28 days. Member Health Statement THIS IS NOT A BILL
PO BOX 1798 532 RIVERSIDE AVENUE JACKSONVILLE, FL 32231-0014 GARY J. BLUE 2121 BLUECROSS WAY JACKSONVILLE, FL 32246-0023 HOW CAN BLUE HELP YOU? If you have any questions about your claims activity, please
More informationFINANCIAL POLICY. I understand and agree to Woodbourne Family Practice Financial Policy. Print Name Date. Signature
FINANCIAL POLICY Woodbourne Family Practice believes that communicating our financial policy is good healthcare practice. Charges incurred for services rendered are the patient s responsibility regardless
More informationGlossary of Terms. Adjudication: The way a health plan decides how much it will pay for certain expenses.
Page 1 Glossary of Terms Adjudication: The way a health plan decides how much it will pay for certain expenses. Affordable Care Act (ACA): The comprehensive health care reform law enacted in March 2010.
More informationRHC Medicare Cost Reporting 101 Katie Jo Raebel, CPA, Partner March 20, 2019
RHC Medicare Cost Reporting 101 Katie Jo Raebel, CPA, Partner March 20, 2019 Wipfli LLP Critical Access Hospital and Rural Health Clinic Conference 0 Today s Agenda Rural Health Clinic Medicare Cost Report
More informationThe Advisory Board Company
The Advisory Board Company Managing Self-Pay in the Current Economic Environment Best Practices and Self-diagnostics February 16 th 19 th, 2010 2010 The Advisory Board Company The Nation s Preeminent Health
More informationOut-of-Network Law (OON) Guidance (Part H of Chapter 60 of the Laws of 2014)
Health Plan Disclosure Requirements Out-of-Network Law (OON) Guidance (Part H of Chapter 60 of the Laws of 2014) 1. Provider Directory: Insurance Law 3217-a(a)(17) and 4324(a)(17) and Public Health Law
More informationCEDI: Hosted Claims Manager and Denials IQ 1
CEDI: Hosted Claims Manager and Denials IQ 1 Centricty EDI Services Today s Presenter Claire Wright EDI Business Development Claire Wright joined IDX/GE back in 2005 as an EDI Support Engineer. After
More informationSacred Heart Health System
Sacred Heart Health System ICD-10 One Year and Counting! Nov. 15, 2013 Anthony Pelezo, M.D., ICD-10 Project Leader Sacred Heart Health System anthony.pelezo@shhpens.org The Only Thing We Have to Fear,
More informationChapter 7. Billing and Claims Processing
Chapter 7. Billing and Claims Processing 7.1 Electronic Claims Submission 3 7.1.1 How it Works... 3 7.1.2 Advantages... 3 7.1.3 How to Initiate... 4 7.1.4 Transactions Available... 5 7.1.5 NAIC Codes...
More informationThe Importance of Insurance Verification, Fee Transparency and Bundling. Helen Lowenwirth, MBA, CASC Administrator East Side Endoscopy, LLC
The Importance of Insurance Verification, Fee Transparency and Bundling Helen Lowenwirth, MBA, CASC Administrator East Side Endoscopy, LLC East Side Endoscopy, LLC New York State Certified Ambulatory Surgery
More informationCalifornia Natural Products: EPO Option Coverage Period: 01/01/ /31/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.deltahealthsystems.com or by calling 1-209-858-2525 Ext
More informationHealth Chapter ALABAMA STATE BOARD OF HEALTH BUREAU OF HEALTH PROVIDER STANDARDS DIVISION OF MANAGED CARE COMPLIANCE CHAPTER
ALABAMA STATE BOARD OF HEALTH BUREAU OF HEALTH PROVIDER STANDARDS DIVISION OF MANAGED CARE COMPLIANCE CHAPTER 420-5-6 HEALTH MAINTENANCE ORGANIZATIONS TABLE OF CONTENTS 420-5-6-.01 General 420-5-6-.02
More informationInnovation Health At-A-Glance
Innovation Health At-A-Glance A quick reference guide for health care professionals 71.02.801.1 A (3/15) innovation-health.com A guide for doing business with Innovation Health Getting started with Innovation
More informationCigna-HealthSpring is one of the leading health plans in the United States focused on caring for the senior population, predominately through
CIGNA-HEALTHSPRING Cigna-HealthSpring is one of the leading health plans in the United States focused on caring for the senior population, predominately through Medicare Advantage and other Medicare and
More informationBuilding Clinical Trial Revenue Integrity Compliance Through Auditing and Understanding Payer Requirements
Building Clinical Trial Revenue Integrity Compliance Through Auditing and Understanding Payer Requirements Kelly Willenberg, DBA, RN, CHRC, CHC, CCRP Kelly Willenberg & Associates Wendy S. Portier, MSN,
More informationAvMed In-Network Tier A Providers: $1,500 individual / $3,000 family AvMed In-Network Tier B Providers: What is the overall deductible?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.avmed.org or by calling 1-800-477-8768. Important Questions
More informationMedicare Advantage 11/02/17 NOT FINAL HANDOUT
FINAL HANDOUT will be provided on 11/2 by Mary Petersen extra attachments are not included in this handout Medicare Advantage: tools and strategies to collecting 5343 North 118 th Court Milwaukee WI 53225
More informationManaged Health Services
Managed Health Services National Provider Identifier MHS needs to obtain NPI numbers prior to January 2008. Please submit directly to MHS for entry into our claims payment system. Submit NPI via MHS Web
More informationGain a Revenue Cycle Advantage with More Effective Contract Management. Brendan Kreter Solutions Engineer
Gain a Revenue Cycle Advantage with More Effective Contract Management Brendan Kreter Solutions Engineer Agenda Pressures in the Industry Snap Shot of Reimbursement Payment Compliance Claims Contract Profitability
More informationElectronic Prior Authorization - Provider Guide
Electronic Prior Authorization - Provider Guide Table of Contents Getting Started 4 Registration 5 Logging In 6 System Configurations (Post Office Settings) 7 Prior Request Form 8 General 8 Patient and
More informationFlorida Workers Compensation
Florida Workers Compensation Reimbursement Manual for Ambulatory Surgical Centers Rule 69L-7.100, F.A.C. 2015 Edition THIS PAGE LEFT INTENTIONALLY BLANK 2015 Edition Page 2 of 42 Effective Date TBD TABLE
More informationCommon Reasons for Claim Denials and Ways to Avoid Them
Common Reasons for Claim Denials and Ways to Avoid Them The lifeblood of any thriving medical practice is a steady cash flow. It is, therefore, of upmost importance to recognize trends in payer denials
More informationTHE FAST AND THE FURIOUS Revenue Cycle 3.0
THE FAST AND THE FURIOUS Revenue Cycle 3.0 HFMA Arkansas Fall Conference October 19, 2017 Jorge Fernandez, Business Development Principal Availity Hospital Solutions Division HFMA Lone Star Chapter Secretary,
More informationHIPAA Transactions: Requirements, Opportunities and Operational Challenges HIPAA SUMMIT WEST
HIPAA Transactions: Requirements, Opportunities and Operational Challenges -------------------------------------- HIPAA SUMMIT WEST June 21, 2001 Tom Hanks Co-Chair Privacy Policy Advisory Group Co-Chair
More informationC H A P T E R 9 : Billing on the UB Claim Form
C H A P T E R 9 : Billing on the UB Claim Form Reviewed/Revised: 10/1/2018 9.0 INTRODUCTION The UB claim form is used to bill for all hospital inpatient, outpatient, emergency room services, dialysis clinic,
More informationCRCS Exam Study Manual Update for 2017
CRCS Exam Study Manual Update for 2017 This document reflects updates made to the instructional content from the Certified Revenue Cycle Specialist (CRCS-I, CRCS-P) Exam Study Manual - 2016 to the 2017
More information