Avoiding the private Dangers of yielding

1500 Health Insurance Claim Form - Avoiding the private Dangers of yielding

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I come to you a day early this week at the beginnings of a vacation.

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1500 Health Insurance Claim Form

My one-week break (save for this space) started with an tantalizing occurrence in my neighborhood. As my family and I were sitting down to supper last night, we saw flashing lights arrival in from our front window. These lights were the beginnings of what turned out to be a conference of four fire engines, one fire Suv (the chief drives stag), two police cars and - one tantalizing expanding to the vehicular melee - an animal control van. It seems that a house over the road from my own in Milwaukee was discovered to include a bevy of unattended exotic wild animals, together with 5 anacondas ranging in length from 20 to 30 feet.

I am very much a man with concrete in my soul. Due to a contented life of urbanization, annoying allergies and a pathological fear of bugs, I've always beloved city life. Say the word "camping" to me and I right away think of a room on the lowest floor of the hotel. Early yesterday, the list of pluses for city living also included the words "....and no tropical snakes!" at the lowest of it. I guess we can scratch that off now. I used to get a good laugh at the local news' "man-in-the-street" interviews with stories like this. It's not so rib-tickling when those sudden Tv personalities are your neighbors talking about an additional one person in your neighborhood who decided on his own to start an unsupervised Brazilian zoo in the middle of your block.

Yesterday's improvised neighborhood reptile round-up was yet an additional one reminder that the world is full of underground dangers. As my mind races at the opinion of what happens the next time I stand in the shower with the water running thanks to my neighbor's keen interest in herpetology, I also spare a opinion to the underground dangers in the world of medical billing, specifically as it relates to yielding and government audits.

I try to justify it to the laymen in the following fashion: every bit of information that goes out on a typical health claim to an assurance carrier has the potential not only for denial, but for larger yielding problems down the road. Try this exercise: find a blank Cms-1500 form some time and start from Box 1 in the upper left hand angle and work your way down all the way to Box 33b in the lower right. In each box, identify a conjecture for that box as to why a claim would be denied by an assurance company. Depending on the payer, the conjecture for the claim, the services being claimed, and a host of other factors, an experienced biller or coder should be able to identify errors that could occur with at least 20 fields that could potentially lead to a claim denial. These could be as simple as "Date of birth entered incorrectly" to "Clia waiver estimate not included in Box 23 for a governmental payer"

The yielding view doesn't stop there. The last request that should be asked before a claim is prepared for billing should always be "Do the services reported on this claim best laid out what is documented in the patient's medical record?". If there is any request whatsoever of the write back being a firm "Yes!", It's best to give the claim a second look.

With some regulatory teeth in case,granted by the patient safety and Affordable Care Act, the yielding landscape for providers of all specialties is about to morph into something more intense than we ever could have imagined just 10 years ago. Five years from today, more sets of eyes will be finding at medical claims than ever before, thanks to an alphabet soup of regulatory agencies both currently in existence and still on the drawing board. Now is more than past the time to internalize the idea that the contents of every claim, much like the house full of serpents down the block, is something that should be taken very seriously.

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