-Any claim that is submitted using the Health Insurance Portability and Accountability Act (HIPAA) mandated transaction ASC X12N 837 (Harrington M.
K 2016).-Claim form used is the UB-04. Professional claims-Any claim that is submitted using the Health Insurance Portability and Accountability Act (HIPAA) mandated transaction ASC X12N 837 (Harrington M.K.
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2016).-Claim form used is the CMS-1500. Why are these important for healthcare administrators?It is important for healthcare administrators to be familiar with the claims process and ensure their facilities claims process is accurate and reliable.
The majority of biller’s day is spent creating and processing medical claims. Billers must be familiar with the type of claim an insurance accepts, and adjust their claim accordingly (www.medicalbillingandcoding.org). Billers will also work with clearinghouses to streamline the claims process. In the process billers must make sure each claim is compliant (www.medicalbillingandcoding.
org). Every claim a biller sends out will ideally be considered “clean”. This means that the claim doesn’t contain any errors and will be processed speedily by the payer (www.medicalbillingandcoding.
org). Clean claims makes it easy for billers to ensure the health providers gets paid quick efficiently. This process may become overwhelming for the biller because it can be a process to make sure claims are being processed correctly (www.medicalbillingandcoding.
org). Accuracy ensures that the medical provider get paid correctly and that the payer pays out correctly. Preparation response to OIGWPS should note any overpayment claims from the six claims that are inaccurate. Second, the hospital should make a notice to the staff specifically the billers of the importance of making claims as error free as possible. Correct coding with the correct number of medical devices is very important in this situation because it was noted the problem of this claim.
Third, WPS must work with the Centers for Medicare and Medicaid Services (CMS) in order to allow FISS repayment corrections. What should WPS do with CMS to improve the process?WPS must work with the Centers for Medicare and Medicaid Services (CMS) in order to allow FISS repayment corrections. Explaining what WPS will do to avoid and fix current problems would be best to prepare for response to the Office of the Inspector General. CMS should always get a second count of what devices were used so future muscount doesn’t occur again. Improvement planAs noted in question three WPS should recover any overpayment claims from the six claims that are inaccurate.
Second, the hospital should make a notice to the staff specifically the billers of the importance of making claims as error free as possible. Correct coding with the correct number of medical devices is very important in this situation because it was noted the problem of this claim. Third, WPS must work with the Centers for Medicare and Medicaid Services (CMS) in order to allow FISS repayment corrections.
I would implement my improvement plan by trying to figure out when and how overpayment of 17,996 occured than making sure staff is aware of their mistakes. Small mistakes can cost a lot so making sure hiring the right staff to handle billing is important or when training takes place make sure new billers are comprehending and grasping all the info before doing work solo.
