Medical Billing

Medical Billing: Basic information about Bankruptcy for Medical bi... : "Bankruptcy laws help people who can no longer pay their creditors get a fresh start – by liquidating ..."

Six Sigma can change the Medical billing process 100% error free industry, since medical billing process involved lot of human work   from the scratch, so effective quality process should be implemented to run the industry smoothly, I personally recommend   Six Sigma is the methodology to erode the error in Medical billing process completely. In all the manufacturing industry we can sell the product if small error occurs in production process, in worst case we can sell it as a scrap, but in medical billing if something goes wrong we cannot collect a single penny from the insurance carrier that too with in a limited time (filling & appealing limit), so as a medical billing person i suggest that Six sigma is the best solution.   This document wholly belongs to Satheesh Kumar, please don’t copy without permission. What is Six Sigma Six Sigma is the measure of quality that strives for near perfection. It is a disciplined, data-driven methodolog

Cross Over : A situation whereby gaps in coverage for the medical expenses for a Medicare Beneficiary are forwarded by the Medicare contractor to the Patient's medigap insurer for payment. Crossover applies only incase of Medicare, medigap and Medicaid plans. Medicare itself transfer the claims to the secondary insurance is called Automatic crossover. even few commercial insurance also doing crossover for the same group plans example BCBS, For Crossover patient must update the COB information with both primary and secondary insurance. Electronic Filling:  It is one that is submitted via electronic format not that traditional paper format   National Standard Format (NSF) It is a format used by the government. It is a rigid format with 320 bytes.   American National Standard Institution (ANSI) It is a format used by the private institutions with 132 bytes It is flexible one.

HMOs A health maintenance organization (HMO) is a type of managed healthcare system. HMOs, preferred provider organizations (PPOs), share the goal of reducing healthcare costs by focusing on preventative care and implementing utilization management controls. Unlike many traditional insurers, HMOs do not merely provide financing for medical care. The HMO actually delivers the treatment as well. Doctors, hospitals, and insurers all participate in the business arrangement known as an HMO. HMOs provide medical treatment on a prepaid basis, which means that HMO members pay a fixed monthly fee, regardless of how much medical care is needed in a given month. In return for this fee, most HMOs provide a wide variety of medical services, from office visits to hospitalization and surgery. With a few exceptions, HMO members must receive their medical treatment from physicians and facilities within the HMO network. The size of this network varies depending