Medical Billing

 

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

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Patient Demographics

Patient browse (search) is the key element for any EMR / PMS Software. In my past 15 years experience, i involved more than 5 times in design/development (using VB6, VB.NET) / test the Patient demographics search and patient demographics page.

Here is the excellent UI which shows how to design patient search window
Patient Search window
or you can see the screen shot here

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MU Certification Smoking Status

For the MU Measure Test Procedure for §170.302 (g) Smoking Status , make sure your software shows both the Smoking status recodes and Smoking status. Because certification bodies will ask to show the code also in the drop down.

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MU Certification

For the measure, Test Procedure for §170.302 (h) Incorporate Laboratory Test Results, we could not able to find or get the HL7 File for the data sets. So by looking the data on each data sets, we created the HL7 File which given here for new people

Data Set 1

Data set 2

Data set 3

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We completed our MU Certification in Nov 2011 itself, but this year only i got time to share / transfer our knowledge/expereince to  others. In the upcoming post, i will share some of my experience in the certification

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Individual and Group NPI

Here is the very good article which explains with simple examples when and where to use Individual and Group NPI.
http://www.iridiumsuite.com/npi-and-billing

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Sample EOB

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