solution manual to accompany pattern classification

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See our Privacy Policy and User Agreement for details.You can change your ad preferences anytime. Policy and Procedure Guide. Page 2 of 45. Table of ContentsPolicy and Procedure Guide. Page 3 of 45. Standards of Conduct. Mission, Goals and Ethical Principles. MBA Medical Billing strives to maintain the highest ethical standards in the industry ofWe endorse the compliance efforts of the OIG and haveThe Compliance Manager works with the management to write and adopt standards;Excluded Individuals and Entities; and report to management on compliance programThe management team will identify risk areas; write policies and procedures; implementPurpose. The Standards of Conduct of MBA Medical Billing Services, Inc ensure compliance withMBA is committed to complying with all state andCompliance with Laws and Regulations. Accurate Claims Coding and Submission: MBA Medical Billing doesAccurate Business Records and Retention: MBA Medical Billing’sIn accordance with OIG regulations, records arePolicy and Procedure Guide. Page 4 of 45. Kickback Prohibition: MBA Medical Billing does not provide incentivesRefund of Overpayments: If MBA Medical Billing determines that anCourtesy Discounts and Waivers of Co-Payments: MBA Medical. Billing does not waive or adjust co-payment or deductible obligations ofHardship, bad debt, and out-of-networkHonesty: MBA Medical Billing will follow ethical business operationsCooperation with Government Investigations: MBA Medical Billing. Services, Inc will be cooperative and forthcoming in any governmentFinancial Interests: MBA Medical Billing’s administrators, employeesConfidential Information: All employees and subcontractors of MBA. Medical Billing are required to sign applicable Confidentiality. http://daehnfeldt.com/userfiles/file/dayton-booster-pump-manual.xml solution manual to accompany pattern classification, solution manual to accompany pattern classification, solution manual to accompany pattern classification chart, solution manual to accompany pattern classification worksheets, solution manual to accompany pattern classification pdf, solution manual to accompany pattern classification method. Agreements (employees) and Second Tier Business Associate AgreementsHealth Insurance Portability and Accountability Act (HIPAA) of 1996. Additionally, confidential information about MBA Medical Billing is notViolations of Standards of Conduct. Violations of MBA Medical Billing’s standards of conduct must be promptly reported toIf the Compliance Manager or another administrative memberPolicy and Procedure Guide. Page 5 of 45. Confidentiality. General Policy. It is our policy that all internal business of MBA Medical Billing Services, Inc isAll requests for disclosureCorrective action will be taken for all violations. Definitions. Confidential Information: Any information, whether written or verbal, relating to theThis includesProcedure. Employees must adhere to the following standards at all times. Employees must never discuss information regarding a client or client’sDiscretion and responsibility are expected and should be exercised by allMedical Billing Services, Inc.Policy and Procedure Guide. Page 6 of 45. Access to Patient Information. Access to a patient’s billing record must be treated with utmost respect andProcedure. It is the responsibility of the Systems Administrator to manage MBA’sIt is the responsibility of the Systems Administrator to regularly reviewIt is the responsibility of the Systems Administrator to review all auditAudit records shall be kept at least six months and custodians shallThe Systems Administrator must periodically review user accessAccess to patient records may be obtained only by those employees whoIncidents or suspicions of unauthorized access to patient informationPolicy and Procedure Guide. Page 7 of 45. Workstations. Rules Governing the Use of Workstations. http://elfath-engineering.com/userfiles/dayton-blower-motor-manual.xml The use of MBA’s information systems or data for personal business orEmployees are prohibited from unauthorized browsing of patient,Every employee will receive a unique username and password forUsernames and passwords should not be shared except under specialEmployees are prohibited from listing their username and password onEmployees should log out when they are not using the practiceEmployees are prohibited from leaving their workstation unattended withEmployees are prohibited from installing unauthorized or illegally-copiedEmployees are prohibited from altering or removing any software or dataEmployees are prohibited from interfering with the operation of any of. MBA’s computer systems or using an MBA workstation to disrupt anyPolicy and Procedure Guide. Page 8 of 45. Claim Generation Process. Procedure. Each employee will assure the following claims processing activities are not participatedSubmitting claims for undocumented services. Unbundling or up-coding. Billing for discharge in lieu of transfer. Improper use of modifiers. Assumption coding. Alteration of documentation. Coding without documentation. Billing for services provided by unqualified personnel. Information will be received from the client in the following format and manner. On paper encounter forms by courier. On electronic encounter forms via a secure portal or encrypted email. A completed encounter form must be received in order to initiate the claims process. AAll patient demographic information including: name, sex, DOB, SSN,Valid CPT4, ASA, or HCPCS codes for all procedures performed. Valid ICD9 codes for all documented diagnoses. Once a group of completed encounter forms has been received, the following steps willA charge batch will be created in the appropriate practice managementThe patient information will be loaded in the system, if it is not alreadyThe encounter information will be keyed into the charge batch. https://www.informaquiz.it/petrgenis1604790/status/flotaganis21052022-1919 After all of the encounter forms are entered the batch will be posted andAfter a batch is posted, insurance claims are filed and submitted to the insurance in oneSubmitted electronically to a clearinghouse. Submitted electronically to the carrier. Printed on a CMS-1500 claim form and mailed to the carrierPolicy and Procedure Guide. Page 9 of 45. Waivers, Discounts and Financial Hardships. MBA Medical Billing Services, Inc.Regulatory Requirements. Federal Register Vol. 63 No. 243, December 18, 1998, p. 70143. The OIG issued. Compliance Program Guidance for Third Party Medical Billing Companies.Billing “insurance only” mayPenalties Law, and State laws.’In such situations the payer shouldFederal Register Vol. 59 No. 65, December 19, 1994, p. 373. Publication of OIG Special. Fraud Alerts.Policy and Procedure Guide. Page 10 of 45. MBA will continuously work to inform clients of the laws governing balanceClients will be encouraged to make good faith efforts to collect all patientClients who continually engage in questionable practices will be reportedEmployees will always adhere to the following policies regarding patient balanceEmployees are forbidden from writing-off patient co-payments,Financial hardship adjustments are not routine but should be decided on aThe following Standard Adjustments are acceptable when performed inContractual adjustments. Out-of-network adjustments. Rebilling fee adjustments. Charity adjustments. Transfer of balances between accounts or to collections. Bad-debt adjustments approved by the providerPolicy and Procedure Guide. Page 11 of 45. Standard Adjustments. MBA Medical Billing Services, Inc only adjusts charges in accordance with writtenPolicies regarding charge adjustmentsContractual Adjustments. Employees are empowered to adjust charges in accordance with contracts between ourContractual adjustments should reference the relevant contract. http://mervemobilya.com/images/7.2-home-network-gateway-manual.pdf Charges are not to be entirely written-off without the authorization of anCharges are not to be reduced below the Medicare allowable for anyMedicaid, Champus, and Workers Compensation). Special circumstances causing an adjustment (such as timely filing) shouldOut of Network Adjustments. MBA recognizes that our clients are unable to contract with every insurer. Some clientsFor these providers we haveIn an effort to make the allowable fair we use it in accordance with the followingTo avoid violating Medicare regulations the allowed amount must beTo avoid discrimination the allowed amount must be applied the same forTo avoid violating the Stark II laws the allowable can’t be used as anTo avoid conflicts with existing contracts the adjustment can’t be usedRebilling Fees. Some clients have authorized MBA to add a rebilling fee to offset the expense ofThese adjustments to theThe client has authorized the use of rebilling fees. A patient has neglected to pay after having been sent 3 or more statements. An account does not receive more than one rebilling fee per month.Policy and Procedure Guide. Page 12 of 45. Charity Adjustments. MBA is aware that our clients participate in programs through which medical services areCollections Adjustments. Employees are expected to make every effort to get a balance paid before transferring theWhen all efforts to collect a balance have been exhaustedProviders must authorize the account to be sent to collections either on aNeither clients nor employees are allowed to discriminate. The sameBad Debt Adjustments. Employees are expected to make every effort to get a balance paid before making a badRebilling fees can be negotiated, reduced, or written-off entirely to badNeither clients nor employees are allowed to discriminate. The samePolicy and Procedure Guide. Page 13 of 45. Bankruptcy. Billing staff are expected to adhere to all legal requirements regarding the handling ofWhen a notice of bankruptcy filing is received all pertinent informationOn the Misys Tiger system the Bill Cycle and Patient Type should indicateThe patient should not receive calls or letters while a bankruptcy isIf a Discharge is received any balances incurred prior to the bankruptcyIf a Dismissal is received the notice should be filed in an EOB file, theMail Return Accounts. When an account statement or other patient correspondence is returned by the post officeIf the attempt is successful theThe old address should be placed in the notes on the account and an alertThe Bill Cycle and Patient Type should indicate a Mail Return status. The undelivered mail should be forwarded to the client in a final attemptIf they are unable to resolve the problemPolicy and Procedure Guide. Page 14 of 45. Bad Debt and Collections. Billing staff will routinely produce account aging reports to identify uncollected balancesDefinitionsInternal Collections: At least two formal letters are sent and two phone calls are made toIf those actions do not produce aExternal Collections: After all resources have been exhausted, remaining accountStandard Adjustments: Amounts added or subtracted to the account balance to reflectWrite-Off: Amount subtracted from an account after the debt has either been eitherProcedure. Billing staff will follow these guidelines when handling bad-debt accounts. Routine monthly aging reports are run to identify and make efforts toAccounts with uncollected balances greater than 90 days will enter theIf no response is received the account ledger is printed out and forwardedAll notes and outcomes are documented on the patient account.Policy and Procedure Guide. Page 15 of 45. Identifying and Reporting Credit Balances. Billing staff will track overpayments and regularly report them to our clients forAll overpayments will beProcedure. All payments will be applied the patient’s account by line item, with the billing staffThe client is responsible to refund overpayments. Clients who regularlyOverpayments are to be tracked in a log and reported to the client withinThe client will receive a copy of the ledger, a copy of any relevant EOB’s,To avoid discrepancy, the payer entitled to the refund will receive a copyOnce a refund is issued the credit balance on the appropriate account willA copy of the check and EOB’s will beAll notes and outcome will be documented on the patient account.Policy and Procedure Guide. Page 16 of 45. Patient Rights. Right to Privacy: Relevant patient information may only be disclosed toRight to Review Information: Patients are entitled to know whichRight to Clear and Complete Presentation of Information: WhenRight to Amend and Correct Information: Information cannot be deleted,Right to Restrict the Use and Disclosure of Specific Information: TheRight to an Accounting for Disclosures of Information: The patient hasRight to Protection of Information Released to Third Parties: MBA. Medical Billing Services, Inc requires that third parties also maintain aPolicy and Procedure Guide. Page 17 of 45. Patient Access to Health Information. It is our policy to respond to information requests in a professional and timely manner. We maintain patient information in our billing records that is sometimes needed inWhen the properProcedure. An individual will be allowed access to pertinent health information from our billingA written request must be received along with a signed authorization fromRequests and resulting actions must be noted in the patient’s account. Requested information must be disclosed to the requesting party within 30Patient Amendment to Health Information. MBA Medical Billing Services, Inc does not respond directly to HIPAA-based requestsWe maintain the information in our billingUnder HIPAA Rule ourDefinitionsProcedure. All individuals requesting amendment should be instructed to contact ourIf we are informed by our client, in writing, of an amendment to a billingAll amendments are to be documented within the appropriate account inPolicy and Procedure Guide. Page 18 of 45. Use and Disclosure of Protected Health Information. MBA Medical Billing Services, Inc is responsible for maintaining and securing healthIn such situations it is mandatory that aThe authorization mustIt is our policy toProcedure. Release of protected health information will occur only within the following guidelines. Prior to any disclosure of PHI an Authorization for Release of InformationThe form must contain. Name or other specific identification of the person(s) or class ofDescription of the information to be used or disclosed must beDate on which the authorization expires. This is 90 days from theSignature of patient, legal guardian or next-of-kin, and date signed. If someone other than the patient is signing the authorization form,The authorization form requests the individual to identify the purpose ofWhen a client requests information contained in the billing record, noThe requested information will be forwarded toIf a request is made by an attorney it will be honored only upon receipt ofServices, Inc to release PHI to the attorney.Right to Access Health Information.Policy and Procedure Guide. Page 19 of 45. De-Identification of Protected Health Information. Our policy on Use and Disclosure of Protected Health Information serves as ourFor all other uses and disclosures weEmployees are required to de-identify individually identifiable PHI by removing theNames. All geographic information below the state level. Street Address. City. County. Precinct. Zip Code (Or Equivalent Geocode). Month and day for all dates directly related to an individual. Birth Date. Admission Date. Discharge Date. Date of Death. All ages over 89 and all elements of dates (including year) indicative ofTelephone numbers. Fax numbers. E-mail addresses. Social Security numbers. Medical record numbers. Health plan beneficiary numbers. Account numbers. Device identifiers and serial numbers. Internet Protocol (IP) address numbers. Biometric identifiers including finger and voice prints. Full face photographic images and any comparable images. Any other unique identifying number, characteristic, or code.Policy and Procedure Guide. Page 20 of 45. General Policy (Continued). If we have any reason to suspect that, after de-identifying the information, the individualShould we believe we will need to re-identify the information at any time in the future,No one outside of MBA is permitted to disclose the codesAny such disclosure will constitute a disclosure of protectedProcedure. The disclosure of De-Identified Protected Health Information can take place only inAll employees will be trained in the de-identification process and theUses or disclosures for treatment, payment, or business operations. When disclosure is required by law or other disclosures allowedWhen an authorization for release has been obtained. It is generally the responsibility of each employee to assure thatWhen large quantities of information must be de-identified we may enlistThat entity will be required toIf we are unable to adequately de-identify information for a requestedPolicy and Procedure Guide. Page 21 of 45. Minimum Necessary Information. When using or disclosing Protected Health Information (PHI), or when requesting PHIHuman Services, disclosures required by law and uses or disclosures that are required forDisclosure for Treatment, Payment or Healthcare Operations. The rules establish that routine and recurring disclosures of PHI can be made forFor all routineCATEGORY 1 - Full health information will be provided to routine and recurringHealthcare Providers. Patients. Family Members Involved In Care. Workers’ Compensation Providers. Transcription Services. CATEGORY 2 - Minimal necessary information will be provided in the followingRequests for medical information to determine necessity. Sample records for accreditation or audits. Records review for protocol adherence. Patient information for participation in clinical trials. Referral requests and certification.Practice Management Support Staff. ClearinghousesTechnical Support StaffPolicy and Procedure Guide. Page 22 of 45. Requests for Information. Federal regulations establish that for routine and recurring requests the responsibility forIn situations where the determination has notPolicy and Procedure Guide. Page 23 of 45. Handling of Privacy Complaints. It is our policy that MBA Medical Billing Services, Inc does not respond directly to. HIPAA-based complaints against healthcare providers. Should a complaint be placedThe HIPAA Privacy Rules give all individuals the right to fileDepartment of Health and Human Services. Under no circumstances will the fact that anProcedure. Patients wishing to file a privacy complaint should be advised of the following. Individuals may submit privacy complaints regarding our company in theAll privacy complaints should be directed to the Compliance Manager. The complaint should describe the privacy concern in as much detail asThe complaint must include the following. The type of infraction involved (Inappropriate handling of PHI. Appropriateness of privacy policies, etc.). A detailed description of the incident or problem. The date the incident or problem occurred, if applicable. The mailing address to which a formal response may be sent.Policy and Procedure Guide. Page 24 of 45. Procedure (Continued). When a privacy complaint is received from a patient the following steps must be taken. The Compliance Manager must confirm that the patient has a completeThe patient should under no circumstances feelIf the individual does not want to pursue the complaint any further, theWe will investigate all non-dismissed complaints by discussing theIf the complaint is determined to be invalid, a letter stating the reasoningIf the complaint is determined to be valid, the responsible employees willOnce disciplinary action has been taken with respect to the complaint, or ifA copy of the letter will be filed with thePolicy and Procedure Guide. Page 25 of 45. Assessing Risk Areas for Fraud, Waste and Abuse. Risk areas in the claims management process will be assessed routinely by performingMBA Medical Billing does not participate in activities thatFalse claims are subject to monetary penalty up toProcedure. Compliance with the laws governing fraud, waste and abuse will be maintained in theNo false or fraudulent claims will knowingly be constructed or submittedAny employee who knowinglyAll expensesIn an effort to promote accuracy, prevent fraud and identify errors in ourPolicy and Procedure Guide. Page 26 of 45. Role as a Clearinghouse. MBA Medical Billing Services, Inc is considered a clearinghouse under the definition setProcedure. As a clearinghouse by definition under HIPAA, MBA Medical Billing Services, IncMBA Medical Billing Services, Inc is subject to the Final Standards for. Privacy and Individually Identifiable Health Information under HIPAA. Our policies reflect our adherence to HIPAA standards and will be strictlyMBA Medical Billing Services, Inc will abide by its Business Associate. Agreement with each of its clients in respect to uses and disclosures ofPolicy and Procedure Guide. Page 27 of 45. Role as a Business Associate. MBA Medical Billing Services, Inc will be considered a business associate to our clientsA business associate is defined as anThis includes claims processing or administration, dataProcedure. As a business associate of our clients MBA Medical Billing Services, Inc will performMBA Medical Billing will submit transactions in a HIPAA standardMBA Medical Billing will perform all obligations outlined in our Business. Associate Agreement as agreed upon with our clients. MBA Medical Billing acknowledges that it signs into a Business. Associate Agreement with each client that meets required elementsMBA Medical Billing will make all internal documentation concerning itsMBA Medical Billing will determine if our clients have violated any. HIPAA, Stark II or other pertinent regulations and address any violationsAgreement. In addition, any suspected violation by MBA will beMBA Medical Billing will oversee the secure storage, return orPolicy and Procedure Guide. Page 28 of 45. Second Tier Business Associates. Independent contractors or agents contracted by MBA Medical Billing Services, Inc willMBA is requiredProcedure. Each independent contractor or business associate not employed by MBA. Medical Billing will be required to sign a Second Tier Business Associate. Agreement with MBA Medical Billing Services, Inc.Second Tier Business Associates must acknowledge a full understandingPolicy and Procedure Guide. Page 29 of 45. Developing Proposals and Service Agreements. The Client Implementation Manager will be responsible for addressing the range andThese services will be outlinedInc. The Client Implementation Manager will discuss with each potential clientThe Client Implementation Manager will create a detailed businessIf the proposal is accepted, the Client Implementation Manager willAgreement, and a checklist indicating all information necessary forServices will commence when all documentation has been completed andPolicy and Procedure Guide. Page 30 of 45. Services, Responsibilities and Fees. The Client Implementation Manager will be responsible for explaining to our clients allThese services will be outlined in the. Billing Agreement entered into by the client and by MBA Medical Billing Services, Inc. Additional services may be added and services may be discontinued or revised inThe responsibilities of each partyFees will be outlined in the Billing Agreement, which must beProcedure. The services provided to our clients are customized to fit the needs of each organization. In addition, the services can be amended with the approval of both MBA and our client. Taking into consideration the potential variation and changes in provided services bothCharge Entry. Claim Submission (Electronic Whenever Possible). Management of Accounts Receivable. Payment Entry and Bank Deposit. Patient Statement Submission. Internal Collections and Patient Balance Review. Management and Support of Information Systems and MBA Network. Customized Encounter Forms. Annual Fee Schedule Review. Courier Service. The following services can be purchased in addition to routine services. Virtual Private Network Connection. Online Access to Billing System. Eligibility and Referral Management. Consulting and Chart Auditing. Payer Contract Negotiations. Office Management. Management of Accounts PayablePolicy and Procedure Guide. Page 31 of 45. The responsibilities of each party are clearly explained to the client prior to their startCharge Entry. The client is responsible for providing a completed encounter formClients must code all procedures and diagnoses to assure that codesMBA is responsible for accurately posting the information into theClaim Submission. The client is responsible to complete and return all documentationMBA is responsible to submit claims electronically to all carriersMBA is responsible to submit paper claims only when electronicManagement of Accounts Receivable. The client is responsible to provide any patient informationMBA is responsible for assuring that all claims are paid by thePayment Entry and Bank Deposit. The client is responsible to provide MBA with deposit slips and anMBA is responsible for posting payments to the appropriate claimsMBA is responsible for depositing payments into the client’s on aPolicy and Procedure Guide. Page 32 of 45. MBA is responsible to track balances and submit monthlyInternal Collections and Patient Balance Review. MBA is responsible for identifying patients who fail to makeMBA is responsible for evaluating the history of such patients andMBA is responsible to execute any necessary steps to clear theThe client is responsible for determining, in a timely manner, if anMBA is responsible for providing all necessary information toManagement and Support of Information Systems and MBA Network. MBA is responsible to maintain and support our network andMBA is responsible to maintain our end of any VPN connectionsThe client is responsible for maintaining and supporting anyPolicy and Procedure Guide. Page 33 of 45. Standard Production Reports and Customized Reports. Clients are responsible to communicate any particular interest orMBA is responsible to provide monthly production reportsMBA is responsible to provide a summary of the Accounts. Receivable to the client at the end of every month. MBA is responsible to provide any reasonably producibleMBA will determine if a requested report is reasonably producible. Customize Encounter Forms. The client is responsible to provide a list of the most commonlyMBA is responsible to periodically review the codes on ourMBA is responsible to recommend encounter form changes to ourThe client is responsible for indicating any changes they wouldMBA is responsible for designing encounter form templates to bestThe client is responsible for mass production of encounter forms. MBA is responsible for reviewing the existing fee schedules of ourThe client is responsible for making the final determinationMBA is responsible to assure that the fees billed for each servicePolicy and Procedure Guide. Page 34 of 45. MBA is responsible to maintain a regularly scheduled courierThursday with the following exceptions:MBA is responsible for informing the client when the courierThe client is responsible to have all documents gathered andFees. Fees are determined by MBA on a client-by-client basis, dependentFees are typically quoted as a percentage of receipts. Services not included in the traditional package are billed inPolicy and Procedure Guide. Page 35 of 45. Interruption of Client Service. When a decision is required regarding client relations following suspected misconduct,Procedure. MBA Medical Billing Services, Inc may suspend, continue or terminate servicesSuspected or known misconduct as defined by the OIG (HIPAA. Violations). Unpaid invoices, past due by 60 days or more. Failure to uphold MBA’s expected standard of integrity. Conditions for reinstating or continuance of agreement. Evidence of appropriate and legal conduct in suspected problem areas. Payment of outstanding invoices. Amendment of practices representing a effort to reach expected standardCause for termination of Billing Agreement. Client is submitting false or fraudulent encounter forms. Client is unethically and illegally assigning procedure or diagnosis codes. Client has been brought under investigation by the OIG for misconduct. Client has been placed on the OIG Excluded List. Ongoing failure to uphold MBA’s expected standard of integrityPolicy and Procedure Guide. Page 36 of 45The client will be notified both orally and in writing within two (2)Documentation will be placed in the client’s file. MBA personnel will be notified in a special private briefing. User access will be denied to the client’s accounts and billing records. When continuance has been approved by the Client Implementation Manager. The client will be notified both orally and in writing within two (2)Documentation will be placed in the client’s file. User access will be restored to the client’s accounts and billing records.