Thursday, January 9, 2020

The Billing Of Billing Medicare - 1587 Words

The billing for services not rendered for are often done as a way of billing Medicare for things or services, that basically never occurred. This can involve forging the signature of those enrolled in Medicare or Medicaid, and the use of bribes or as Healthcare calls it, kickbacks to corrupt healthcare professionals. Upcoding of services is the act of billing Medicare programs for services that are more costly than the actual procedure that was done. Upcoding of items is also very similar to upcoding of services, but it involves the use of medical equipment. For example, billing Medicare for a highly sophisticated and expensive wheelchair, while only giving the patient a manual wheelchair is upcoding of items. Duplicating claims occur when a provider does not submit exactly the same bill, but alters small things such as the date in order to charge Medicare twice for the same service rendered. Therefore rather than a single claim being filed twice, the same service is billed two tim es in an attempt to receive payments from the government twice. Unbundling involves bills for particular services are submitted as fragmentary, which appear to be staggered out over time. Although, these services would normally cost less when bundled together, but by manipulating the claim, a higher charge is billed to Medicare resulting in a higher pay out to the party committing the healthcare fraud. Excessive services occur when Medicare is billed for something greater than what the level ofShow MoreRelatedThe Reimbursement Of Medical Services Essay1434 Words   |  6 Pagescredentials of the clinician, inappropriate billing and coding, and unreflective documentation. NPs can express medical services through â€Å"incident-to† or independent billing for third-party payer claims such as Medicaid, Medicare, and private insurance companies. â€Å"Incident-to† billing categorizes the patient under the physician or NP; however, the bill is submitted utilizing the phys ician’s National Provider Identification (NPI) number. Contrary, with independent billing, the patient is billed under the NPIRead MoreU.s. Health Care System1611 Words   |  7 Pagesnumber of uninsured are all dynamics of the increased cost in health care. The U.S. health care system relies heavily on third-party payers; these payers include commercial insurers and the Federal and state governments. According to the Centers for Medicare and Medicaid Services, or CMS, the National Health Expenditure grew 3.6% to $2.9 trillion in 2013, or $9,255 per person, and accounted for 17.4% of Gross Domestic Product (GDP). Id. National health expenditures (NHE) are projected to grow at an averageRead MoreThe Recovery Audit Programs ( Rac )983 Words   |  4 PagesRecovery Audit Programs (RAC) is to identify any Medicare collection that is under any detection and collection of overpayments that are made on claims of health care services that are provided by Medicare beneficiaries, and to identify any payments that are provided so that CMS can take any actions that can prevent future improper payments in all 50 states. RAC programs is a successful program that utilizes the recovery Audit to identify ant Medicare overpayments and underpayments to health care providerRead MoreHealthcare Fraud and Abuse1065 Words   |  5 Pageshead into the next four years under the Obama administration, many Americans are hearing more and more about healthcare reform and what needs to be done to fix the ailing healthcare system. Part of the dramatic increase in healthcare costs is due to Medicare fraud abuse. Healthcare fraud is defined as making false statements or representations of material facts in order to obtain benefits or payment. Healthcare abuse is defined as practices involving the overuse or misuse of services, either accidentallyRead MoreEssay on Centers for Medicare and Medicaid Services and Reimbursement1324 Words   |  6 PagesIs national certification important with respect to billing and reimbursement? When? Discuss reimbursement barriers and issues that hinder or prevent APNs from receiving reimbursement for services rendered. What are steps APNs must take to increase the likelihood for reimbursement? Qiuyue Li Asuza Pacific University Karen D French 02/12/13 1. The Question I believe national certification is important with respect to billing and reimbursement. National certification is often required inRead MoreQuality Assessment Of A Medical Biller And Team Player With A Positive Attitude1439 Words   |  6 PagesBiller with experience in physician billing across many different specialties. Effective multi-tasker and demonstrated team player with a positive attitude. Seeking a position requiring automated and clearinghouse billing systems expertise. Desires a challenging role as a Medical Biller and Collections Representative. Core Qualifications †¢ CPT and HCPCS coding OB-GYN, surgery, gastro, ENT, ortho experience †¢ Quality assessment of coded data Internal medicine billing †¢ Strong planning skills HIPAA complianceRead MoreEvaluating Compliance Strategies Essay621 Words   |  3 PagesValencia Axia College of University of Phoenix Billing and Coding compliance strategies protect physicians from financial risk and potential loss of revenues. Physicians must document fully the service they provide and put in force a plan that prevent or reduce coding errors. According to, â€Å"The Journal of the National Medical Association,† there are 10 top billing concerns for physicians: Medicare billing (Part A and Part B) Mental health billing. Self-Referring to entities where the physicianRead MoreMedicare: The United States First Medical Social Insurance Program847 Words   |  3 Pageseconomic hazards (as unemployment, old age, or disability) in which the government participates or enforces the participation of employers and affected individuals† (1). The United States government operates several national social insurance programs. Medicare is the United States’ first medical social insurance program. This program was designed to provide health insurance to the elderly and protect them from financial hardship due to illness. A thorough investigation of this program reveals the overallRead MoreHealth Care At Mayo Clinic1147 Words   |  5 PagesClinic includes: Aeta, Allied Benefit Systems, Assurant Health, Blue Cross Blue Shield, Cigma, Humana, Meritain Health, and United Health Care (n.d., Mayo Clinic). The Mayo Clinic also accepts Medicare and Medicaid. Medicare has two parts: Medicare Part A helps pa y for inpatient hospital services; whereas Medicare Part B helps pay for clinical services and outpatient hospital services (n.d., Mayo Clinic). Some Medicaid programs are accepted with coverage limitations. Out-of-state Medicaid is not acceptedRead MoreMedicare Fraud Essay988 Words   |  4 Pageseliminate Medicare prescription fraud. Patients abusing or selling painkillers received by visiting several doctors and obtaining multiple prescriptions costs Medicare millions annually. Fraud affects everyone, preventing it requires government officials and citizens diligently working together. Protection from Medicare Insurance Fraud Medicare provides healthcare coverage for individuals over the age of 65, in addition, to others meeting certain criteria. The government funds Medicare through

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.