Work with Physician to Achieve Maximum Reimbursement

Outline

1. Introduction

The introduction describes reimbursement as a dynamic area of healthcare. This area has been affected by many trends and transformation in healthcare in the previous years. This section also provides an overview of fee-for-services, Medicaid and Medicare in relation to physician reimbursement.

2. Charting

This part describes the patient demographic and insurance information and First-time patients at every visit, as well as the need of verification of patient demographic data.

3. Scheduling

This includes the use of script or sheet guide and the type of patient insurance among others.

4. Diagnostic Coding

The medical practice has to ascertain who will be accountable for coding or verification of the proper codes for the procedures, services, and diagnoses.

5. Procedure Codes

For hard procedures, there is need for inquiry on the physicians demonstrating the code descriptors to aid in the determination on the suitable code

6. Evaluation and Management Codes

It remains significant to confirm the correctness of the encoder data.

7. CMS 1500 and Insurance Forms

CMS-1500 is the medical insurance claim form utilized in the submission of professional and physician claims for healthcare providers. It remains significant to work closely with healthcare personnel and providers in the development of an approach of capturing non-office charges

8. Others
9. Reference

Introduction

Reimbursement is a dynamic area of healthcare. This area has been affected by many trends and transformation in healthcare in the previous years. However, with the introduction of Medicaid and Medicare, the reimbursement for doctors has gone down. On the same note, fee-for-services have been discussed by third-party payers with doctors that have seen the physician reimbursement decreasing. The administrative stress on healthcare racket and mistreatment, as well as compliance, has brought a meaning to the significance of accurate billing. As a result, healthcare practices have continued to work towards improving their processes of the revenue cycle (Crocker, 2006).

Charting

At every visit, patient demographic data is supposed to be verified. First-time patients and minimally yearly for verified patients, the data form is supposed to be filled by an individual patient. The information comprises of the entire patient demographic and insurance information. The forms should later be reviewed by a staff member. For Medicare patients, the Medical Secondary Payer questionnaire is supposed to be filled or updated during registration to perk up the patients’ flow (Crocker, 2006).

Scheduling

With Front-end of the Revenue Cycle, the cycle begins with patient rescheduling. This includes the use of script or sheet guide and the type of patient insurance among others (Crocker, 2006).

Diagnostic Coding

The medical practice has to ascertain who will be accountable for coding or verification of the proper codes for the procedures, services, and diagnoses. However, it remains significant to validate the correctness of the encoder data. Networking with comparable coding issues practices can be obliging, with a suitable caution (Crocker, 2006).

Procedure Codes

For hard procedures, inquire on the physicians demonstrating them the code descriptors to aid in the determination on the suitable code. Besides the coding resources already stated, the provider’s area of expertise society may as well provide coding leadership. Be certain modifiers remain properly appended and identified as needed. Like the documentation audits with those audits, coding audits is supposed to be completed (Crocker, 2006).

Evaluation and Management Codes

Practice management systems often have an “encoder,” which can aid in the diagnoses codes selection. It remains significant to confirm the correctness of the encoder data. It is not odd in which the codes in the encoder have been entered by a variety of employees’ members of the health practice and may perhaps fail to  reflect the most suitable code or most definite code.

CMS 1500 and Insurance Forms

The CMS-1500 is the medical insurance claim form utilized in the submission of professional and physician claims for healthcare providers. It remains significant to mark procedures, services, and diagnoses on the encounter form with the support of medical record documentation. However, it remains significant to work closely with healthcare personnel and providers in the development of an approach of capturing non-office charges (Crocker, 2006).

Others

Other processes include Claims Transmission, Payment Posting, Denial Management, and Working Accounts Receivable.

Reference

Crocker, J. (2006). How to improve your revenue cycle processes in a clinic or physician practice. How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice/AHIMA, American Health Information Management Association. Web: http://library.ahima.org/doc?oid=73917