Steps in the Medical Billing Process Essay Example for Free

Steps in the Medical Billing Process Essay The medical billing process and all of the functions that pertain to it are the responsibilities of the medical insurance specialist. It addresses all tasks that will be performed by the administrative staff members during the medical billing process. These functions are typically handled by front office staff members such as the receptionist (registration) and scheduling. Here are ten steps that will be explained which are the responsibility of the medical the medical insurance specialist. Step 1: Preregister patients * There are two main tasks that are involved when patients are at the preregistration period of their initial visit. These tasks include scheduling and bringing up to date any appointments that they may have. Step 2: Establish financial responsibility for visits * This is a very important step because it involves the determining of who is financially responsible for the visit. It also is used to establish what services may be covered under the type of insurance they have, along with payment options plan options if any, and what types may be available to the patient. Step 3: Check in patients * This step is used to check in patients, this is also the point at which new patients will provide information about themselves. A complete and detailed demographic review of their medical information will be collected at this time by the front desk. When returning patients arrive, they are asked to review the information and provide changes, if any. Step 4: Check out patients * The check-out procedure follows when the patient is done and ready to leave, once the physician and has given the patient their diagnosis and other procedures are complete. This is also the step in the visit where all expenses of the visit are tallied and the patient is brought to awareness of the amount owed in their ledger. Step 5: Review coding compliance * This area is formatted so that all official requirements are met. Meaning all official guidelines that are assigned to the codes will be followed to their standard purpose. Checking for errors when codes are assigned once diagnosis and procedures are selected is critical at this time so the patient will able to understand their charges. Step 6: Check billing compliance * Most medical practices have a standard set of fees listed, and each visit is related to a specific procedure code. Although each code is not necessarily billable, there are separate fees associated with each of the codes that are. Knowing the codes and the procedure that goes with it is important so that the correct charges are applied and the guidelines are still being followed. Step 7: Prepare and transmit claims * A claim is meant to communicate any information about the patient diagnosis given by their physician, it may also be used for the reimbursement of services that have been rendered. Most practices prepare the claim and send them off electronically. Step 8: Monitor payer adjudication * Here all procedures are listed and monitored, and any unpaid charges are explained. The codes on the payment transactions are viewed to make sure they match the on the claim form, and the payment listed for each procedure is correct in accordance to the contract with the payer Step 9: General patient statements * This procedure breaks down what bills will be covered by the insurance plan and what bills are expected to be covered by the patient. It will provide the patient with the service dates for each fee, and when and how much they are expected to pay for the services. Step 10: Follow up patient payments and handle collections * Patient medical records and financial records are filed and retained in accordance to the medical practice’s policy. They are regularly reviewed and analyzed to see if their financial responsibilities have been met. Federal and State regulations govern what documents are to be kept, and the amount of time. Reference Part 1: Chapter 1 Working with Medical Insurance and Billing pp. 16-21

Avian Song Control :: Birds Bird Neorology Essays

Avian Song Control Bird songs continue to fascinate neurobiologists and neuroethologists because the development of song has been a popular model used to examine the role of environment on behavior. In most species, only male birds sing complex songs. Their vocalizations are the result of sexual dimorphism in the brain regions responsible for the production of song. However, this behavior is not genetically hardwired into the avian brain. Certain conditions must exist in order for male birds to successfully produce their species-specific song. Additionally, the neuronal circuitry and structure of the avian song system shows high levels of plasticity. If the brain and behavior are indistinguishable, then the structural differences in the avian brain are responsible for behavioral differences across the sexes. Nottebohm and colleagues identified six anatomically distinct regions of the forebrain involved in the production of song, which are arranged into two independent pathways, the posterior pathway, which controls song production, and the anterior pathway, which controls song learning. The collective unit is typically referred to as the vocal control region (VCR) (1) (2). Female birds sing rarely and this behavioral difference is reflective of the anatomy of the female avian brain. There are significant differences in the size of three neural areas involved in the production of song across the sexes, and a specific area, Area X, is present in the male and absent in the female. Additionally, the incorporation of radiolabeled testosterone in certain locations is different in males and females (3) (4). Scientists have been particularly interested in the origin of the structural differences in male and female songbirds. Research has suggested the importance of gonadal hormones, specifically testosterone in the production of song. It was observed that castration eliminated all song production (5). Additionally, when testosterone levels are low, there is not only a decrease in the production of song, but also a decrease in the size of some nuclei involved in song production (6). Further support for the necessity of testosterone for song production was demonstrated by Nottebohm (1980) when he injected female birds with testosterone, which lead to the production of song (7). This research has interesting implications regarding anatomical changes that may occur when an organism is chemically imbalanced. Disruptions in chemical equilibrium may alter brain structure and subsequently influence behavior. Nevertheless, not all research has supported the claim that testosterone is responsible for anatomical and behavioral differences between male and female songbirds. Avian Song Control :: Birds Bird Neorology Essays Avian Song Control Bird songs continue to fascinate neurobiologists and neuroethologists because the development of song has been a popular model used to examine the role of environment on behavior. In most species, only male birds sing complex songs. Their vocalizations are the result of sexual dimorphism in the brain regions responsible for the production of song. However, this behavior is not genetically hardwired into the avian brain. Certain conditions must exist in order for male birds to successfully produce their species-specific song. Additionally, the neuronal circuitry and structure of the avian song system shows high levels of plasticity. If the brain and behavior are indistinguishable, then the structural differences in the avian brain are responsible for behavioral differences across the sexes. Nottebohm and colleagues identified six anatomically distinct regions of the forebrain involved in the production of song, which are arranged into two independent pathways, the posterior pathway, which controls song production, and the anterior pathway, which controls song learning. The collective unit is typically referred to as the vocal control region (VCR) (1) (2). Female birds sing rarely and this behavioral difference is reflective of the anatomy of the female avian brain. There are significant differences in the size of three neural areas involved in the production of song across the sexes, and a specific area, Area X, is present in the male and absent in the female. Additionally, the incorporation of radiolabeled testosterone in certain locations is different in males and females (3) (4). Scientists have been particularly interested in the origin of the structural differences in male and female songbirds. Research has suggested the importance of gonadal hormones, specifically testosterone in the production of song. It was observed that castration eliminated all song production (5). Additionally, when testosterone levels are low, there is not only a decrease in the production of song, but also a decrease in the size of some nuclei involved in song production (6). Further support for the necessity of testosterone for song production was demonstrated by Nottebohm (1980) when he injected female birds with testosterone, which lead to the production of song (7). This research has interesting implications regarding anatomical changes that may occur when an organism is chemically imbalanced. Disruptions in chemical equilibrium may alter brain structure and subsequently influence behavior. Nevertheless, not all research has supported the claim that testosterone is responsible for anatomical and behavioral differences between male and female songbirds.

Boston Lyric Opera Essay

1. BLO’s eight customer objectives The first objective is to gain generous contributions. The amount per donator, ration between new donators and new contacts (collection rate) and the total amount of the donators and contributions are ways to measure how this aspect is doing. Incentives for the staff should also be incorporated into these objectives, especially ones that steer the process towards multi-year support programs. To measure the board involvement and recruitment, it is important that the reputation of the new board member is blameless and since operating in Boston, a local person with strong ties to the community would be better. To measure involvement the easiest way is to look the member’s activity, how many times they’ve been in meetings and how they’ve acted to build strategy. For example number of new initiatives. Also hours spent educating the board members about strategy and vision could be one measurement. Building an artistic reputation is hard and so is measuring it. Reviews on papers give a sight how the opera is doing, but the best way to know is to make a consumer survey for example once a month. Also comparing the growth in visitors between BLO and other operas gives an idea. Rating different aspects is another way to measure the artistic view. Giving value for example to the lead singer or the orchestra will help to understand how the opera is doing on its main field. These measures aren’t very proactive though, but helpful anyway. One objective is to launch a residency program. Its success can be measured by the amount of acceptances to invites and by comparing the audience amounts to normal. Like when measuring artistic reputation, the best way to measure how exciting and diverse opera’s repertories are is to see reviews and audience amounts. The grading system works when the given grades are compared to the rivals’ same grades and the shows are compared. These are of course not proactive measures. BLO wants to collaborate with other major artistic institutions like museums and theatres. Also other operas and specially talents working in them are important. One way to measure collaboration is the amount of tickets to opera that our associates sell. How many per cent of the total amount of sold tickets is it and have these collaborations brought new visitors to BLO. Community support and focus on community programs can be measured with the amount of local donators and specially the amount of new supporters. Has the PR-campaign been affective? Have local companies supported the opera? This can be measured with the amount of companies. Measurements that measure processes in line with the strategy are not always easy to find and it usually takes a lot of time to find the right ways to use them. Often they need to be adjusted or reset to fit the strategy. The main challenge is to find measures that are pro-active and directive instead of controlling. 2. Boston Lyric Opera had not really measured their organizational performance before. This had ultimately caused lack of focus and limited accountability. Boston Lyric Opera was mainly led by qualitative values as quantitative measures and financials were not the topmost factors in decision making. The new general director Janice Del Sesto and BLO’s board acknowledged that there was a history of expensive opera productions and large losses in Boston’s opera scene and they had to adapt a new business philosophy in order to operate fiscally. Non-profit organizations often have a lack of focus and their strategy concentrates to too many things at the same time. Ken Freed, a BLO board member, acknowledged that a more formal strategic planning process was essential for BLO in order to avoid mistakes that several arts organizations had made in the past. They decided to adapt the Balanced Scorecard to focus their strategic planning process. Using the Balanced Scorecard, BLO and its employees could see their day-to-day activities within a bigger and more strategic context. They started the change by defining BLO’s mission, strategy, competitive advantages, and distinguishing characteristics that would make it unique. The biggest change here was BLO reshaping its strategy. They acknowledged that their most important â€Å"customers† in this situation are the people who resourced their organization. BLO received nearly 70 percent of their operating budget from sources other than ticket sales, mostly from donors and supporters. BLO decided to place donors and supporters as their main interest group in the Balanced Scorecard. They were the body that enabled BLO to carry out their mission and strategy. Even though Boston Lyric Opera is a non-profit organization and its output is intangible, its organizational performance can be measured by quantitative measures. The Balanced Scorecard would bring quantitative measures alongside the qualitative measures. The Balanced Scorecard required BLO to quantify their activities. BLO acknowledged that and they for example created a database where they linked quantifiable donor data to qualitative information about donor meetings etc. Basically, the Balanced Scorecard required BLO to be managed like a business. 3. Lyric Opera had a new question ahead of them. They had to figure out what they wanted to become. BLO’s existing strategy was not valid anymore as their operating expenses rose and revenues from ticket sales were limited. BLO decided to adapt the Balance Scorecard in order to set new strategic objectives and measure their performance against those objectives in order to overcome to challenges they were facing. Adapting the Balanced Scorecard, BLO was able to compose a clear and precise strategy. Actually, the strategy itself was quite complex and multidimensional but the Balanced Scorecard gave it a framework that presented the new strategy clearly. BLO set three strategic themes that they felt were important in reaching their goals and they had objectives and measures of success for all of the themes. Using the Balanced Scorecard and the strategy map, BLO was also able to communicate the new strategy clearly to their staff, stakeholders, and other associates. The fact that BLO now had sufficient information of their organization and operations, it could draw new donors to them. By using the Balanced Scorecard, BLO recognized their key success drivers and they started to focus on the activities that had the greatest impact on their goals. They all had a clear common goal and BLO’s staff worked cross-departmentally, motivationally to reach the goal of providing unique, uality opera in Boston. However Jessica Del Sesto and Sue Dahling-Sullivan faced some difficult challenges and barriers to capture the above-mentioned benefits. There was some opposition from a few board-members of changing the organization’s governance structure, adapting the Balance Scorecard and managing an art organization by quantitative measures. These â€Å"old school† members did not under stand that BLO could not compete with the great opera houses and they could not standout from the crow without differentiating in some way. Del Sesto and Dahling-Sullivan were still able to carry out the new strategy and capture the benefits to make BLO a highly successful arts organization. One of the most crucial parts of the adapting a new strategy was to communicate the strategy clearly to their staff, board members and other stakeholders. It is an unconditional requirement that people understand the new strategy and its benefits in order it to succeed. Del Sesto and Dahling-Sullivan used the strategy map in communicating the new strategy and it clearly presented the reasons and benefits of the new strategy and it lighten opposition substantially. . The departmental managers and the employees of BLO are more empowered after the BSC but the artistic leaders are less. The managers are now more empowered because every department now gets to plan its own scorecard, and describe the ways how the department would meet the high level strategic goals. The employees are with the scorecard more empowered, as they can see the w ork in a more strategic context and therefore set priorities more effectively themselves. However the artistic leaders felt that the scorecard and specially the repertory planning template could limit their opportunities in designing productions. . Del Sesto uses the BSC as a managerial system. The BSC purely concentrates on the big picture; everything is based to support strategy. Del Sesto believes that the BSC helps her to steer board members’ attention to proper tasks. Also, she thanks BSC for helping employees to think more strategically, and with greater clarity towards their objectives. All in all, Del Sesto is clearly more interested on the management aspect of the BSC. One explanation to this is that BLO is a nonprofit organization. Its reason to exist is not to make profit to its owners but to offer culture to the community. All the objectives connected to the three main points are easier to measure with controlling measurements. 6. Kaplan and Norton have studied the success of BSC implementations in different organizations. They have concluded five principals that contribute greatly to the success. These principals can also be found on BLO’s BSC implementation. The process started with planning. Group consisting members from all functions thought in several meeting how the BSC should be made and what BLO is now and what it wants to be. All possible views were brought to conversations and the members were challenged to use their imagination. As a result the group made three strategic themes which determined the main points to BLO’s future strategy. These three big themes were divided to smaller parts and brought to a form that is clear to everyone in the organization. This is similar to Kaplan’s and Norton’s principal 1, where the strategy is translated in to operational terms. The BSC was completed by determining the actions to be made so that the strategy can be fulfilled. After this all parts of the organization got to make scorecards of their own and were so committed to the strategy. The whole organization was aligned to meet the strategy (Principle 2). The project succeeded because BLO was able to find the crucial processes and finish them through. The personnel were part of the developing strongly. During the process of creating the BSC, the role of the entire staff in overall success was emphasized. This made them easier to adapt the new way of doing things and easier to understand the strategy and how it can be fulfilled (Principle 3). Often when BSC implementation fails it is because the scorecard is considered to be only management’s project, just a top-level adjustment. As always with large scale organizational changes, also this project faced some resistance. Some board members and artistic staff were unsure about the motives for changing the old customs. This problem however was solved, as the need for change was successfully communicated through various levels of the organization (Principle 5). Other crucial point which was done well was the targeting. The mission was announced clearly and the goals were easy to understand. The three major themes were chosen wisely and chopped in to smaller pieces well.

International Trade Law And The United States - 1968 Words

All countries apply the rule of law, but the systems in each country differ. For example, while the UK has common law, the USA uses civil law, so this can see that countries apply differing approaches to jurisdiction and the law. International Trade Law governs cross-border trade in goods and services and serves to provide a legal framework for exchanges between parties located in different countries. In these circumstances, it is common that the trading parties are not familiar with each other before engaging in trade, so International Trade Law can help mitigate the risks involved and offer protection to the trading parties. The existence of International Trade Law has the potential to mitigate a number of potential difficulties which contracting parties might face. Various situations have been presented which have not been adequately addressed by current trade laws; frequently these arise when parties are based in different countries which operate different legal systems and when the parties had not specified which legal system would apply to their agreed contracts. The issues of whose laws will apply and which court shall have jurisdiction is an ongoing concern in global trade. The issue can be resolved through the consideration of rules governing conflict of laws, these also often differ between the legal systems in the countries of the parties involved in the conflict. 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