Errors in Medical Claims Processing Cost Health Care System Billions Each Year

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Landlords were able to bid to have the clean water service in their compound if: We structured it to help us understand the business model that would work for scaling up.

What was it like getting landlords interested? We plan to disseminate the results to the Bangladesh government and other organizations working on increasing access to safe water later this summer with the hopes that they are interested in implementing the chlorine dosers.

We are also now expanding the project to roadside water stands in Kenya, and working on a business model that would work in other countries. Finally, does this make you think more about the water you drink? This research definitely increased my awareness of water quality and safety, even in my home town. Public water in developed countries is generally very safe, but there are still contaminants, like lead, and I do sometimes worry about that when my kids drink.

I am so grateful that I can just go to the sink and get a glass of clean water! Very interesting strategy to increase clean water access. I work for Miller Center for Social Entrepreneurship, and last year I partnered with a clean water social enterprise in Indonesia called Nazava.

They try to address the issue through in-home water filters. From our research, they seemed to have quite a lot of impact especially in more rural places. It's always fascinating for me to see the different innovative ways that we can address this important issue in areas around the world!

Keep up the good work! Also if you were interested in our impact evaluation for the Nazava strategy it can be found here http: As a plumber I'm very aware of the engagement challenges surrounding well-being and water in-community.

It can be a negative-option purchase or task. So, it was nice to see the grass-roots technological connection between science and people Hi, i saw your comment on regards of multipurpose solar power treatment plant.

In other words, reality defies the stereotypes. Practitioners and insurance companies must continue to adopt high-quality electronic billing and payment systems that can cut down on processing errors and remove the hassle of having to deal with both paper checks and electronic payments. The other key recommendation is that insurers adopt a standardized coding system for claims—similar perhaps to the one adopted several years ago by Medicare. The fact that a single provider could be dealing with hundreds, if not thousands, of sets of benefits for their patients is ludicrous.

I'm not sure we have a nurse per bed, but we have a billing clerk per bed. But it generally ignores the fact that consumers are ultimately the ones left holding the bill for claims errors. If an insurer kicks back a charge and refuses payment to a provider, the responsibility shifts to us. A report released in March from the Government Accountability Office GAO indicated that insurers denied coverage more frequently because of billing errors —such as duplicate claims or missing information—and for eligibility issues, services were provided before coverage was initiated or without pre-certification than because they deemed care medically inappropriate.

The GAO report also found that when coverage denials were appealed, they were frequently reversed in the consumer's favor. In California, for example, the denial rate for six managed care insurers ranged from 6 percent to 40 percent in Whether you're insured by a plan that kicks out many claims or only a few, it may pay to appeal.

Under the Patient Protection and Affordable Care Act, all patients will have to be notified that if a claim is denied, they have the right to an internal review by the insurer and also with an independent review board. Achieving further cuts in the administrative costs of health care will require that insurers streamline their claims processing and convert to a more universal coding system.

Only then will these savings move downstream to providers and, ultimately consumers. So for now, I like millions of other annoyed Americans, will continue to test my endurance and keep following up on suspect medical charges and care denials.

Now, when can I set aside an hour to wrangle with that collection agency? While having my varicose veins treated, I chatted with my doctor about health insurance.

He said he was against the Affordable Care Act, but as we talked he admitted that dealing with Medicare was so much easier than working with insurance companies. He said that, while Medicare pays less, at least they pay quickly. Insurance companies, on the other hand, ask for more information, reject claims, and generally seem to find ways to delay payments.

Has anyone calculated the added cost to health care from doctors having more support staff than nurses in their office? The private insurance system we have is so inefficient and wasteful — and this does not include profits.

In a day of universal bar codes and scanners there is no reason to manually code any equipment or disposable supplies. A portable scanner could have tracked that splint as easily as a can of tuna, ordered a replacement for inventory purposes and noted the account to which it was billed. What am I missing? Is it because they pay electronically? Medicare has well-established rules based on code combinations that appear on the claim.

They will automatically reject or deny what is inappropriate based on these rules. SpeedECoder is software that contains all these rules at http: Health plans and providers must share their responsibility of making the innovations and investments needed to improve efficiency in our health care system. Naomi- You are being too generous in calling this a billing error — it was likely intentional overbilling.

In my personal experience, most medical bills are padded — a 5-minute visit billed as a minute visit, a cursory ER examination billed as a level 4, a simple neeedle aspiration billed as incision or drainage, excision of a 3 mm lesion billed as excision of a 20 mm lesion. All of these bills passed insurance company screening, These were not clerical errors — They were adjusted by the treating physicians only when I told them that I was a physician who directly witnessed the procedure and would file a complaint to the state medical board about fraudulent billing.

This will take us from some 14, codes currently to 69, In the meantime, both providers and insurers will have to spend tens of millions of dollars to reprogram their computers to get ready for the changeover. A PA who saw me in the ER Fast track is trying to bill me for a pulse reading he did not do when I was seen for a back injury related to my part time hospice job. New to me too even though I once worked in an orthopedic ward.

But having our own lingo is one of the ways we doctors control the closed shop called Healthcare. That as some of the commentators here have noticed is in the Art of Billing. Needless to say the publication of the ICD will be helpful at least to doctors in this regard. I had a similar experience. My son broke his foot and the ER put him in a cast up to his upper thigh.

When I got him to our family orthopedist, he took the cast off and said NO cast was necessary, just that my son should stay off the foot and wrap it if it made it more comfortable. Retrieved May 2, Retrieved May 9, Retrieved May 16, Archived from the original on October 16, Retrieved October 13, Archived from the original on October 22, Retrieved October 20, Archived from the original on October 20, Retrieved October 10, Archived from the original on October 19, Retrieved October 17, Archived from the original on October 25, Retrieved October 24, Retrieved November 7, Archived from the original on May 30, Retrieved November 14, Retrieved November 21, Archived from the original on February 1, Retrieved January 30, Archived from the original on February 7, Retrieved February 6, Archived from the original on February 14, Retrieved February 13, Retrieved February 20, Archived from the original on March 1, Retrieved February 27, Archived from the original on March 8, Retrieved March 6, Retrieved March 13, Archived from the original on March 22, Retrieved March 20, Archived from the original on March 30, Retrieved March 27, Archived from the original on April 7, Retrieved April 3, Archived from the original on April 13, Retrieved April 10, Archived from the original on April 18, Retrieved April 17, Archived from the original on April 27, Retrieved April 24, Archived from the original on May 4, Retrieved May 1, Archived from the original on May 10, Retrieved July 4, Archived from the original on May 17, Retrieved May 15, Retrieved September 25, Retrieved October 2, TV By the Numbers.

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