#clearinghouse

[wanderingfool2023]

How it works on the inside - billing inside hospitals and clinics

Years in this field. There are not enough words to explain my anger at the system. The primary point is that it is broken, everyone on the "inside" has known for ages, COVID was the death knell.

I could make post after post on why it is broken but I think it is easier to explain how it is intended to work for the first one. Because I will be real with you people on the inside that WORK ON THESE TEAMS do not even fully get it.

This example is for a hospital (think ortho, cancer centers, surgery, etc) - clinics, like your primary care clinic use a very simplified version of this.

The first people you usually speak to are called "Patient Registrars" the team is usually called PAS (Patient Access Services). These are the front line staff that get you scheduled, take your insurance, get your authorizations. It is the doctor that SENDS the referral who is responsible for getting your initial authorization. Usually this is for a consult. The authorizations after are done by the folks above.

Side bar - what is an authorization? it is a request by your doctor for something you need that the payor/insurance company agrees that they will pay for. These can be for a one time service like a MRI, or something that is based upon time/dosage - like chemo. The latter must have re-auths done by the team mentioned above.

Lets say this all goes according to plan, which it does for the most part. What happens after you get your first visit?

The doctor goes into their medical record (sometimes called an ELECTRONIC MEDICAL/HEALTH RECORD -EMR/EHR; these used to not be electronic and be on paper, some facilities are still on paper. The medical field is the last bastion of faxing in this nation) and documents what was found/discussed - their diagnosis, prescriptions, next steps like treatment or routine meetings etc.

That information (regardless of format) flows to a team called the Medical Records Team. They do a QA, make sure the registration folks didn't miss any forms, the nursing staff got all the stuff they need and then ship it over to coding/charging.

Now this next step does involve traditionally 2 teams. It can deviate by facility, some are merged, some are not. Lets talk about a bigggg ass facility with all the proper teams and staff.

Charging - this is a sub team of either 3 different departments: Health Information Management (HIM), Patient Financial Services (PFS), or Revenue Integrity (RI). Regardless these folks sit down, review what the doctor wrote and generate charge codes based upon it. There is a dictionary (several truly) in every hospital with every price for every service. These prices are set based upon a few factors but I will delve into that in another post called Charge Master or CDM.

From there it goes to coding. Coding reviews these records and documents in extreme depth. They assign codes (which are dictated by CMS - the gov office that oversees Medicare) that is digestible to insurance companies. If anything looks off they send it back to the correct team to fix - most of the time their communication is directly with the doctors themselves. These communications are part of your EHR and available to you if you request them.

Once coding is done then it goes to billing/PFS. PFS then does another QA (sometimes this is done via the tools not a human) and a claiml is generated and sent to a clearing house.

A clearing house is not a bank - it is like a transit center for facilities and insurance companies and their banks (Change Healthcare is owned by UHC and is the biggest clearinghouse in the nation). So a claim goes to the clearing house, it is scrubbed AGAIN for errors, and then sent to the respective insurance company. The insurance company then goes through a fun little circus which is again another post. Eventually they tell the facility (via the clearing house) the claim is either denied, partially denied or fully approved and sends the $ to the clearing house. Sometimes that money goes directly to the bank of the facility ymmv. Regardless the PFS team goes and pulls this data from the clearing house and updates the patients record accordingly.

They will then begin the denial process of fighting the insurance companies. There are hundreds of denial types, but generally they are called technical denials or medical necessity denials. Another post.

This usually takes months of arguing, sending information, resubmitting, rinse and repeat. At the very very end of it the patient (only if the insurance agrees) gets a bill. From THERE the patients will then reconnect with the hospital billing team and maybe the financial assistance team.

This lovely system is called the REVENUE CYCLE. It is sometimes a division, sometimes its left as standalone departments, each functioning on their own. Sometimes the facility is small enough there is only 1 person responsible for a function instead of teams.

I will make a few more posts - specifically break downs. Reach out if you want me to dive into anything specific.

[fleetdrive360]

Avoid costly HOS violations and keep your fleet running smoothly. FleetDrive360 helps you understand complex HOS regulations  and provides tools for electronic logging (ELD) management and driver monitoring.  Reduce your risk of fines, improve driver compliance, and ensure a safer fleet.

[saywhat-politics]

WASHINGTON — Today, GIFFORDS, the national gun violence prevention organization founded by former Congresswoman Gabrielle Giffords, condemned the Trump administration’s decision to shut down the Federal School Safety Clearinghouse External Advisory Board.

As Education Week reported, “The Federal School Safety Clearinghouse, an interagency effort housed in the U.S. Department of Homeland Security, was created by President Donald Trump’s first administration after the Parkland shooting to share resources and best practices related to school safety. Parkland victims’ families, who rushed to advocacy work after the tragedy, pushed for its creation after they grew concerned that research on school safety was confusing for educators and the public to navigate. The clearinghouse was codified into law as part of the 2022 Bipartisan Safer Communities Act, which also mandated the creation of the external advisory board.”

“Dismantling the Federal School Safety Clearinghouse’s advisory board is a betrayal of Parkland victims’ families and their tireless advocacy. This board was created during Trump’s first administration after 17 students and staff died, and it represented a moment of bipartisan cooperation to address school violence, providing critical research and guidance to protect American children. By disbanding this crucial resource, the new Trump administration is choosing the gun lobby’s will over student safety. It is shameful,” said GIFFORDS Executive Director Emma Brown.

According to the K–12 School Shooting Database there were 330 shootings at schools in 2024.

[3liza]

"why do you talk about something awful so much" it has surprised me quite a bit as I've gotten older but the 2000s-2010s SA culture has only become more relevant to current events and media as time goes on, i assume from the natural watershed effects from people aging into their 30s and making media properties that go on to become incredibly influential. I was never a big poster there, I was a lurker 99% of the time and had zero influence on the site, so it's really not personal for me except for stuff like Dropsy, since I was there for the original thread. the SA millennials started popping up in noticeable ways as early as 30 Rock (recall the "lemon party" recurring joke for example) and as the younger members age into their prime output years we're just going to keep seeing more of it.

[lukewarmbreadatamoderatepace]

team of scientists in Omelas studying the phenomenon of "tortured child = utopia" trying to figure out if there are sneaky ways to reduce the child's suffering without disrupting the utopic effects

they're unsuccessful and become very depressed and eventually lose funding. no money in un-torturing a child

different team of scientists studying if "The Omelas Effect" can be extended to other cities; do they need their own tortured children too, do bigger cities with more people need more tortured children for the same amount of utopia?

why does the effect care about geopolitical borders anyway, they say.

Assuming you only ever need one tortured child for a theoretically infinite number of people, should Omelas start invading its neighbors with the eventual goal of conquering the world. getting a lot more utopia per tortured child that way. respecting the child's sacrifice (unwilling). maybe they have a moral obligation to do it. does a perfect utopia even have the capacity to wage war. does the utopia effect mean they can just ask really niceys and it'll work

a political faction says the kid has it too easy, sure they're starving and freezing in miserable squalor but they're just sitting there, we should put them to work too, being the Omelas child is no excuse for not also being a productive member of society.

eventually this becomes some kind of system where the tortured child will ~earn their freedom~ if they meet some impossible work quota. if the kid doesn't want to be tortured they should simply work harder, they're stuck down in that freezing pit because they're lazy.

[hockeybazooka]

Okay y'all did some more snooping on juraj,:

This stuff is like 2 years old I'm pretty sure

He had a fling over the summer w/ this girl from the Czech republic Veronika vobecka

shes a content creator w/ I think 90k+ followers on ig and 282k+ on tiktok

she was the one who went to Spain w/ him

Im pretty sure the vid of a girl walking w/ juraj is her

It was only a fling but she was dragging it out to the point where juraj wanted nothing to do w/ her and unliked all her posts and probably blocked her lmao. I'm pretty sure shes calmed down since then since she unfollowed him. Though I cant speak Czech or Slovak so, but she had fan pages making ship edits of her and juraj together oml y'all and giving her his last name: slafkovska and, her friends would comment on her tiktoks about him too I think. Oh apparently shes a major entitled asshat though lol

Ive heard he flirts w/ the waitress at this restaurant in Montreal the habs frequent, dk if its true though?? That's all I have for now ;p

[hometoursandotherstuff]

The House that Publishers Clearinghouse Built. The architect firm that designed Epcot also designed a house for Harold & LuEsther Mertz, founders of Publishers Clearing House, the direct marketing company known for its sweepstakes and prize-based games. Built in 1979 in Longwood, Florida, it has 9bds, 11ba, and is offered for sale for $5.5M.

Are the stones wearing off the front door? Look at the overpass- it does kinda look like the monorail at Epcot.

Am I right?

Look at the indoor garden under the stairs.

The upper level.

What's with all the dopey little statues all over the place?

The living room. I bet there's a housekeeper just for dusting all the statues.

Looking down from your monorail to the living room.

Great conservatory, but I'm guessin' the parents sat in those chairs listening to their kid practice the piano.

The dining room has some sort of multi-faceted ceiling.

I'm getting confused by the mirrored images.

This retro kitchen stayed so clean b/c I don't think anyone ever used it. I would be afraid of getting sucked up by that exhaust hood. Beam me up, Scotty.

Family room/library/office combo has a great mezzanine.

As if the primary bedroom isn't big enough, there's an anteroom, too.

Huge primary bedroom. They can take that furniture with them.

There's a lot going on in here. Sunken tub, mirrored walls, glass walls, busts enjoying the show, King Henry VIII painted on the wall outside, and a carpeted floor.

Water feature in the garden.

The pool looks a little lonely and forlorn in front of the mausoleum style guest house.

I think that this is the fish-stocked pond where you can fish off your own bridge.

Lay of the land - notice there're staff quarters in the upper right corner.

[alacants]

What if you had a baby!alpha Carlos who's had no training, doesn't know what he is.

And Juanki unexpectedly goes into heat in training. But doesn't think anything of it because there's no alpha's around

But then baby!alpha Carlos is just struck with the urge to bite, to claim, that sense of 'mine' and he's super confused. As is Juanki.

alas for extremely boring rl reasons this is one of the few ships i can't do 😔 BUT i know there are many enjoyers in the vicinity who may wish to take this idea and run with it!!

[hellostranger1961]

such a weight has been lifted from my shoulders. the community college i took classes at during my senior year of high school (2019-2020, mind you) sent in transcripts to my university. which means i do not have to take freshman writing classes next semester!!!!!!!!!! i am officially graduating in may, bitch!!!!!!!!!!!!! 🍾🍾🍾🍾

[saxafimedianetwork]

Ethiopia and Somaliland: Strengthening Economic Cooperation

#Ethiopia & #Somaliland strengthen economic ties with the launch of the Ethiopian Transit Clearinghouse at #BerberaPort, enhancing trade efficiency & regional integration. A significant step towards a stronger partnership, paving the way for broader #EconomicCooperation in #HoA

Continue reading Ethiopia and Somaliland: Strengthening Economic Cooperation

[dotsapsolutions]

[truxsolutionsinc]

TruxSolutions Clearinghouse Registration Services for Trucking Companies

Ensure compliance with FMCSA regulations with TruxSolutions' Clearinghouse Registration services. We assist trucking companies in setting up and managing their Drug & Alcohol Clearinghouse accounts, keeping you updated and compliant. Our experts handle the process efficiently, allowing you to focus on your operations. Simplify compliance with TruxSolutions and ensure your fleet meets all regulatory requirements seamlessly. Contact us today for hassle-free Clearinghouse registration and ongoing support.

[wildbeautifuldamned]

Antique 1920's Rat Perfume Figural Bottle from Germany ebay Diane's Clearinghouse

[punjabtruckdriving-school]

Understanding CDL driver registration necessitates grasping clearinghouse nuances and CDL DOT mandates. Punjab Truck Driving School's resource elucidates the crucial elements, including CDL drug test protocols, essential for successful registration. Discover the streamlined FMCSA Clearinghouse registration process and its benefits for prospective drivers.

[premierlabexpress]

Premier Lab Express

Quick and Discreet Drug & Alcohol Testing

Address- 1425 N. Dallas Ave Ste.216, Lancaster, TX, USA 75134

Phone- +1 877-481-5778

Email- info@premierlabexpress.com

Website- https://premierlabexpress.com

Premier Lab Express offers quick and discreet drug & alcohol testing at our office or your location. We manage your DOT and Non-DOT random programs and are DATIA Accredited and Certified DOT Collectors. We specialize in providing on-site collections for to the ports, rail yards, oilfields, and warehouse testing at your location or any other location. We also offer comprehensive lab testing for accidents, workplace injuries, DNA, and COVID-19 testing. Same Day Service, Urine, Hair, ETG, Employment, Court, DOT/Non-DOT. Schedule Online 24/7.

Business Hours- Mon -Sat: 7AM - 6PM.

Payment Methods- Visa, Mastercard.

Follow On-

Instagram-      https://www.instagram.com/premierlabexpress/