Requirement Constraints

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Thursday, 1 March 2012

Medical Billing

Posted on 03:06 by Unknown

 

I strongly feel that Development of PMS Product is more on the domain/business logic other than the technology. So would to like to share the information in PMS thru my blog

There are lot of articles/books/document sitting on my desk which I have collected from various sources for the past 10 years. From that, so I will try to educate on that in a simple and easy to understandable way with an example where never necessary.

Chapter 1: Introduction
1. What is Medical Billing Process ?
2. Different Format of Medical Form.
3. Patient Insurance
4. Electronic Claim Transmission
5. Medical Billing Clearing house
6. Medical Billing Process in detail
7. Healthcare Coding system.
8. Maintaining Patient Insurance in the software.

Chapter 2:  EDI Transactions

1. What is an EDI ?
2. EDI Transactions 

3. Understanding EDI Structure
4. EDI Instruction

 

 

Chapter 3: Payment
1.
Types of Reimbursement


Chapter 4: Claim Submission after Primary Insurance
1. How to submit the claims after primary insurance ?


Chapter 5: Claim Processing by the insurance company

1. Claims adjudication and Payment process.?


 

New to Health care Domain ?  Here are some documents which can help you to understand the basics.  I am trying to refer to official link(where i downloaded the document)   and as well as link to my server(some time, official links are broken).

1. Introduction_to_Health_Care_in_USA   (or you can click here to download)
2.
Medicare Incentive Program Beginners guide MU Stage 1 ( or you can click here to download)


All about Prescription

  •  An Introduction to ePrescription
  •  How ePrescribing works
  •  Paper Prescription workflow
  •  Electronic Prescription workflow
  •  Refill Paper Prescription workflow
  •  Refill Electronic Prescription workflow

Flow charts

  •  Medical Billing Overview 
  •  Rooming Overview
  •  Medical Billing Flow chart
  •  EMR Test Visit Flow chart
  •  EMR Patient Examination Flow chart
  •  EMR Office visit Flow chart
  •  Medical Claim Life Cycle
  •  Claim Adjudication and Payment Flow chart
  •  EMR Office Visit
  •  Billing Flow chart


Medical Billing blogs

  • Blog on Medical Billing – Revenue Cycle Management
  • Medical Billing and Coding
  • Medical billing CPT modifiers
  • CMS 1500 claim and UB 04 form
  • Medicare Fee Schedule, Payment and Reimbursement
  • Insurance claim denial and appeal
Read More
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