Quality Tools for Medical billing process

1)Cause & effect diagram ( Fish bone chart)

Identifies many possible causes for an effect or problem and sorts ideas into useful categories (like coding related or insurance related).

2) Check sheet

A structured, prepared form for collecting and analyzing data; a generic tool that can be adapted for a wide variety of purposes.

3)Control Chart ( Graph)

Graphs used to study how a process changes over time

4)Histogram

The most commonly used graph for showing frequency distributions, or how often each different value in a set of data occurs.

5)Pareto Chart

Shows on a bar graph which factors are more significant

6) Scatter Diagram

Graphs pairs of numerical data, one variable on each axis, to look for a relationship.

7) Stratification

A technique that separates data gathered from a variety of sources so that patterns can be seen (some lists replace "stratification" with "flowchart" or "run chart").

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What is QMB / MQMB stands for?

In Medical billing or Healthcare industry The term QMB stands for Qualified Medicare Beneficiary & MQMB stands for Medicare Qualified Medicare Beneficiary. The term "QMB" or "MQMB" on the form indicates the client is a Qualified Medicare Beneficiary (QMB) or a Medicaid Qualified Medicare Beneficiary (MQMB). The Medicare Catastrophic Coverage Act of 1988 requires Medicare premiums, deductibles, and coinsurance payments to be paid for individuals who meet the following criteria: Important: Clients limited to QMB are not eligible for THSteps or THSteps-CCP Medicaid benefits. Note: Clients eligible for STAR+PLUS who have Medicare and Medicaid are MQMBs. Medicaid reimburses for the coinsurance and deductibles as well as Medicaid-only services for the MQMB client. QMBs do not receive Medicaid benefits other than Medicare deductible and coinsurance liabilities. MQMBs do qualify for Medicaid benefits not covered by Medicare in addition ...

Key Performance Indicators (KPIs) for Successful Revenue Cycle Management (RCM) in Healthcare Organizations

Revenue Cycle Management (RCM) is an essential process for healthcare organizations to ensure that they receive timely and accurate payments for the services they provide. Here are some of the key performance indicators (KPIs) metrics that healthcare organizations should track as part of their RCM process: Gross Collection Rate (GCR): This metric measures the percentage of charges that a healthcare organization collects from patients and insurance companies. It is calculated by dividing the total payments received by the total charges billed. Net Collection Rate (NCR): The NCR measures the percentage of expected payments received by the healthcare organization after accounting for contractual adjustments, bad debts, and other adjustments. It is calculated by dividing the total payments received by the total expected payments. Days in Accounts Receivable (DAR): This metric measures the average number of days it takes fo...

Rejection Procedure note qualifier is missing

Need to check the Charges tab and double click on the Procedure Code line to open up the Charge Entry window. There is a Notes section on the right hand side. If there is a note typed, we need to select the type. Need to select field and select the appropriate type of note you are sending. Save the changes made Check all the procedure if submitted many procedure. Save the visit again and submit the claim.

Medical Billing

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