Wednesday, 28 August 2013
Thursday, 22 August 2013
Wednesday, 21 August 2013
Friday, 16 August 2013
How patient insurances are maintained in the EMR/PMS software's ?
Today, software's are maintaining the patient insurance in difference ways. Each method has its own cons and pros. I will list those methods which i found in my past experience.
Before getting into detail, let us see the terms "Primary", Secondary, Tertiary and 4th Insurance". In some software, instead of calling 4th Insurance, they will call as Quaternary Insurance.
Actually, there is no defined process or method to identify which is patient primary insurance , and which is patient secondary insurance, and so on. For more details, please download this article and you will know how it has been identified. Since there is no defined way, most of the time, reception people will enter the secondary insurance information into primary and vice versa. That's the reason, all the software's providing swapping option for the insurance
Here you can always maintain 2 or 4 insurance at active state. Give important to the word "Active" here. But, HIPAA EDI 837 Transaction allow up to 11 insurance. So what happens, at one point of time, the existing insurance get expired and patient got new insurance ? Well, you cannot remove that insurance from the system it because it is tightly linked to Billing (Claims) Module. So only the option is to de activate the existing primary insurance and add new insurance in the active state as primary Insurance.
Method : 2
In this method, initially, the insurance are maintained at the patient level. But when the claim is created, software will take a copy of all insurance and will maintain along with part of the claim details. So here, after the claim is created, the insurance at the patient level is plugged off and will not have tightly linked with the claim. If any error in the policy details, of course, first we should correct at the claim level and then at the patient level for error free future claims.
Method : 3
What will be in the patient case. ?
1. Patient case is by patient
2. Software allows to create N number of patient cases for each patient.
3. The following details will be maintained at the patient case
- Referring Physician
- ICDs and CPTs
- Insurance (Here you can define upto 11 Insurance)
- Insurance Authorization information for each insurance if available
- ICDs and CPTs
- For hospital type of visits, maintain different dates such as admitted date, discharge date, accident date, etc..
Creating individual cases for why a patient is being seen by a provider simplifies the selection of insurance policies and the order in which two or more insurance plans may be billed for various types of treatment and conditions. For example, you may have a patient that is being treated for injuries sustained from an auto accident that is covered under one insurance policy; yet that same patient may receive treatment during the same visit for a condition unrelated to the auto accident where a different policy may be billed.
Creating individual cases for patient treatment also simplifies how paperwork and claims are processed when a case involves an attorney lien or Workers' Comp claim. For example, you could have an existing patient that has been previously seen for an illness; and later sustains an injury at his place of employment that may involve a worker's comp claim. How claims are handled for each of these two cases is quite different. In a situation like this, you would simply locate the existing patient record; and then create a new case for that patient that covers treatment for his injury.
Happy Insurance Maintaining !!!!!!
Welcome to the Most challenging part of the Medical Billing !!!!
Interested to see some sample screen shots for Patient case ? Here you go.
Friday, 9 August 2013
Wednesday, 7 August 2013
Friday, 2 August 2013
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