3 2 Final Project Milestone One Draft of Evaluation.docx

Resubmission for claim adjudication in a timely

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resubmission for claim adjudication in a timely manner, the claim will be denied for timely filing errors. According to the source, Medical and Coding Online (2018), the difference between a rejected claim and a denied claim is, a denied claim has been determined by the payer as unpayable. These denials are sometime explained by the payer with an EOB (Explanation of Benefits) and can be appealed and reprocessed at times. A rejected claim is a claim that contains errors, such as missing elements, Chief Complaint, ROS, DOS, and Diagnosis codes that must be corrected and resubmitted for adjudication.
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3 Milestone One: Monthly Compliance Report Policy Changes and Recommendations It is my recommendation that the process flow and current policies be corrected as soon as possible. By implementing the mock/audit process will help educate and catch any billing and coding errors. However, if patient encounters are not properly recorded and documented in the first place by the providers, than by implementing the mock/audit process will not help with this. Therefore, I would start with a meeting with all physicians and staff members. What about their process that is causing encounter errors? Is their encounter process easy to execute? Perhaps review of the clinic’s current EHR system. Does it provide quick and easy access to patient information and accessible from various departments for consultations?
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  • Fall '18
  • Physician, SNHU Medical Clinic

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Christopher Reinemann
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