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Digital Seminar

Insurance Billing, Claims, & Collections


Faculty:
Cheryl C. House, RMC, CHI,
Duration:
5 Hours 11 Minutes
Format:
Audio and Video
Copyright:
Dec 30, 2015
Product Code:
WDS020024
Brochure Code:
WDIBCC14 (P)
Media Type:
Digital Seminar
Access:
Never expires.


Description

Insurance Billing and Claims
Effective insurance and managed care billing and collection is now a critical function for almost every health care provider. Unfortunately, most providers have not gained, but lost revenue potential due to changes in the insurance industry. The industry has now moved into the world of Internet Based Policies and Procedures, Electronic Medical Record (EMR), and Electronic Claims Submission.

With 30 years of consulting, management, and billing in the health care industry, Cheryl House helps you prepare for insurance claims, submittals, and follow-up strategies. Ms. House shares techniques for interpreting different insurance contracts and understanding medical policies to yield positive results. By the end of this seminar, participants can begin building a Compliance Plan that helps their facilities regulate high-risk areas. Whether you are a novice or veteran, you can expect to receive current and expert advice that can be utilized immediately.

 


Course Content

BILLING & CODING TOOLS

  • Understanding the billing process and billing terminology
  • Current reference materials
  • Written policies and procedures covering billing protocol from insurance contractors
  • ICD-9-CM diagnosis coding expertise (ICD-10 as of 10/1/2014)
  • Well-designed patient information form or EMR (patient demographics)
  • Understanding the insurance claims process
  • Understanding the Health Insurance Portability and Accountability Act (HIPAA) and how it relates to claims processing

 

WHAT PAYERS WANT: DOCUMENTATION PRINCIPLES & MEDICAL NECESSITY

  • The site of service
  • Medical necessity and appropriateness of the diagnostic
  • Therapeutic services provided
  • Information that the services provided have been accurately reported

 

REVALUATING EVALUATION & MANAGEMENT CODING

  • What are the elements of an evaluation and management code
  • Getting paid for what you do

 

CLAIMS APPEALS: A KEY TO REIMBURSEMENT

  • Implementing processes for appeals
  • Determining an auditing staff
  • Collection reports in determining appeals
  • Appeals with EMR
  • Understanding the explanation of benefits and remittance advice
  • Proof of timely filing
  • Developing an appeal letter

 

UNDERSTANDING FEDERAL AGENCIES THAT AUDIT

  • Main governmental agencies auditing
  • What is a CMS medical review?
  • Components of a Medicare review
  • Understanding national coverage determinations
  • CERT, RAC, ZPIC, Medicaid Integrity Contractors
  • Medicare Administrative Contractors

 

AUDITING MEDICAL RECORDS

  • Medicare data banks
  • Goals for an audit
  • Types of audits
  • DATA mining: predictive analysis
  • CMS targets
  • Documentation principles

 

DEFINING FRAUD & ABUSE

  • False Claims Act
  • Anti-Kickback Statutes
  • Physician Self-Referral Law
  • Medicare’s Fraud and Abuse Partnerships
  • Office of Inspector General and HEAT program

 

WHAT IS MEDICAL NECESSITY?

  • Medical necessity: the deciding factor in claims payment
  • Medicare definition of medical necessity
  • AMA definition of medical necessity
  • Diagnoses frequently monitored for medical necessity

 

CREATING A COMPLIANCE PLAN

  • OIG Guidelines
  • Following the OIG work plan for auditing
  • Compliance education
  • Developing a compliance plan for your business office

 

PROPOSED CMS CHANGES FOR 2014

  • OPPS payment changes
  • IPPS payment changes

 

ICD-10: A PREVIEW

  • Structure
  • Principles of ICD-10
  • Training for ICD-10
  • Impact on ICD-10 in your IT departments
  • Physician impact
  • Character meaning

Credits


Other Professions

This educational offering qualifies for 6 continuing education hour(s) as required by many national, state and local licensing boards and professional organizations. Save your course outline and certificate of completion, and contact your own board or organization for specific filing requirements. 



Handouts

Faculty

Cheryl C. House, RMC, CHI, Related seminars and products


CHERYL C. HOUSE, RMC, CHI, is the president and partner of CCH Medical Consultants, a consulting and management firm, and the Compliance Auditor for Illinois CancerCare. Ms. House has been in consulting, management, and billing for more than 30 years. She serves on the Illinois Valley Community College as a Healthcare Instructor for their Medical Billing and Coding program.

Formerly, Ms. House served as a Healthcare Director for New Horizons Learning Centers in their Healthcare Information Management Department. Through the course of her career, she has been a health care educator, practice manager, and collections manager for some of the major hospital systems in the Midwest. Ms. House's responsibilities included classroom teaching and reimbursement problem-solving.

Ms. House is author of several coding training manuals and has been the editor of several coding and computer newsletters. Her extensive administrative and financial managed care experience deals with all aspects of health care billing. She is a Registered Medical Coder through The Medical Management Institute and a Certified Healthcare Instructor through National Healthcare Association and certified through AAPC as a Certified Evaluation and Management Coder. Ms. House is a very knowledgeable billing and managed care consultant as well as an excellent seminar instructor.


Additional Info

Program Information

Access for Self-Study (Non-Interactive) Access never expires for this product.

Target Audience

Billing, Insurance, and Coding Personnel, Physician Office Managers, Insurance Managers, Business Managers, Financial Managers, Medical Assistants, Medical Records Personnel

 

Reviews

5
4
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1

Overall:      5

Total Reviews: 1

Satisfaction Guarantee
Your satisfaction is our goal and our guarantee. Concerns should be addressed to: PO Box 1000, Eau Claire, WI 54702-1000 or call 1-800-844-8260.

ADA Needs

We would be happy to accommodate your ADA needs; please call our Customer Service Department for more information at 1-800-844-8260.

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