1. Introduction
(25%) Provide a brief synopsis of the meaning (not a description) of
each Chapter and articles you read, in your own words.
2. Your Strategies
(50%)
a. Briefly compare
the CMS-1500 paper claim and the 837 electronic.
b. Discussion the information contained in the claim
management dialog box
c. Analyze the method used to submit electronic claims.
d. Discuss the use of the PM/HER to monitor claims.
3. Conclusion
(15%)
Briefly summarize
your thoughts & conclusion to this assignment and your appraisal of the
articles and Chapter you read. How did
these articles and Chapters impact your thoughts about Claim Management? How
this Administrative Analysis help you in relation to Claim management in
Medisoft.
Evaluation will be
based on how clearly you respond to the above, in particular:
a) The clarity with which you present and analyzed the
strategies;
b) The depth, scope, and organization of your Administrative
Analysis paper; and,
c) Your conclusions, including a description of the impact
of these articles and Chapters on any Healthcare Organization.
Expert Solution Preview
Introduction:
The Chapters and articles that I have read focus on claim management systems in the healthcare industry. The primary objective of these resources is to help medical college students understand the different strategies and tools available to manage claims effectively.
Strategies:
a. The CMS-1500 paper claim is a standard medical billing form that healthcare providers use to bill for services rendered. On the other hand, the 837 electronic claim is a format used to submit healthcare transactions electronically. Compared to the CMS-1500 paper claim, the 837 electronic claim is faster, less cumbersome, and more cost-effective.
b. The claim management dialog box contains essential information about the patient, the provider, and the services rendered. It also contains information about the payment status, the date of service, and the amount charged.
c. The method used to submit electronic claims involves the use of special software that translates the 837 claim into a standard format that can be understood by the insurance company. The software also allows providers to track the status of their claims in real-time.
d. The PM/HER is a system used to monitor claims, track patient information, and manage appointment schedules. It can also be used to integrate electronic billing and claims management processes to improve workflow and efficiency.
Conclusion:
In conclusion, the Chapters and articles I have read have helped me understand the critical role of claim management systems in the healthcare industry. Effective claim management is essential for healthcare providers, as it ensures timely and accurate payments, improves patient satisfaction, and promotes financial stability. The strategies discussed in this assignment have provided valuable insights into how medical college students can leverage innovative tools and technologies to manage claims effectively. Overall, these resources have been instrumental in helping me gain a deeper appreciation for the importance of claim management in the healthcare industry.
