CASE STUDIES 4
Mrs.Jones is an established patient after having visited the samefacility six months in the past. Additionally, she gets an annualgynecological evaluation and other treatments from the same facility.Since she is an established patient, her records will be updatedbefore she gets to the visit. When she comes, the insurance providerand the policy numbers will be confirmed. The age and the addresswill also form part of the information she will have to confirm uponarrival. Validation of the services covered by the insurance willalso be part of this process. After the examination and treatment aredone, they will be entered into her records. Once they are allaccomplished, the billing will be finished according to the coverage.That will be executed according to each of the services by the twoproviders (Sommers et al., 2014). Essentially, there are the serviceswhich are covered by the two, which means that there will be thedivision of each of the items before sending the bills to respectiveproviders. Medicare is the primary cover for this patient.
Itis the first visit that Mr. Jones is making to this hospital, whichmakes him a new patient. The registration process will be done whenthe patients get to the hospital. Additionally, the health history ofthe patient will be collected. The hospital will require personalinformation of the individual both for record keeping and for thebilling process. The names and address of the patient will berecorded, and there will also be the age and reasons for the visit.Insurance information, such as the provider and the policy number,will also be collected. The patient has more than one insurancecover, which explains that there will be a collection of the employerand the cover, which is given at the place of work (Schmidt, Gostin,& Emanuel, 2015). Indeed, that will guide on the distribution ofthe bill between the insurance covers. All the services offered tothe patient will then be entered into the patient record before it issent to the respective insurance companies. The employer’s healthplan is the primary and is the first to get billed (Cossman, Cossman,Rogers, & McBride, 2014).
Mr.Shelby has never treated Jack before. Additionally, he does not workin the same facility as Dr Zane. Therefore, he will be a new patientat the hospital where he is referred. Since he has never visited thathospital before, he will be a new patient. There will be thecollection of the names and the age of the patient. However, he doesnot have his cover but is a dependent (Caskey et al., 2014).Therefore, the names of the mother will be collected. Informationabout her insurance provider, such as the name of the company and thepolicy number that she holds, will also be collected. The insuranceof the father also covers Jack. Therefore, his information will alsobe given to the hospital. The information will include the names andthe address. Insurance information including the company and thepolicy number will also be necessary (Ortiz, 2014). After treatment,all the services rendered to the patient will get entered into thepatient record. The services will then be translated into a uniformcode, which will then be sent to the insurance company. Since themother is the custodian, her insurance is primary.
Caskey,R., Zaman, J., Nam, H., Chae, S. R., Williams, L., Mathew, G., … &Boyd, A. D. (2014). The transition to ICD-10-CM: Challenges forpediatric practice. Pediatrics, 134(1),31-36.Retrieved fromhttp://pubmedcentralcanada.ca/pmcc/articles/PMC4531279/
Cossman,R. E., Cossman, J. S., Rogers, S., & McBride, D. (2014). Accessto primary care physicians differs by health insurance coverage inMississippi. Obstetrics/gynecology, 91,0. Retrieved fromhttp://s3.amazonaws.com/academia.edu.documents/44018817/Access_to_Primary_Care_Physicians_Differ20160323-27375-1o8cg5o.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1491333969&Signature=ru9kk1lWIKWVqH2S1TtNxcIG2nE%3D&response-content-disposition=inline%3B%20filename%3DAccess_to_primary_care_physicians_differ.pd
Ortiz,A. (2014). U.S.Patent Application No. 14/450,534.Retrieved from https://www.google.com/patents/US20160034986
Schmidt,H., Gostin, L. O., & Emanuel, E. J. (2015). Public health,universal health coverage, and Sustainable Development Goals: canthey coexist? Retrieved fromhttp://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=2503&context=facpub
Sommers,B. D., Musco, T., Finegold, K., Gunja, M. Z., Burke, A., &McDowell, A. M. (2014). Health reform and changes in health insurancecoverage in 2014. NewEngland Journal of Medicine, 371(9),867-874.Retrieved fromhttp://www.nejm.org/doi/full/10.1056/NEJMsr1406753#t=article
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