A/R – Medical Billing and Reimbursement

Health Information Systems Technology

Prepared by: Karen A. Bollin
November 26, 2018
 TABLE OF CONTENTS

LETTER TO SITE DIRECTOR……………………………………………… 3

OVERVIEW…………………………………………………………………… 4
GOAL STATEMENT…………………………………………………………. 5
PROJECT SCOPE…………………………………………………………… 6
DELIVERABLES……………………………………………………………… 7
RESOURCES………………………………………………………………… 8
R ISKS……………………………………………………………………….. 9
TIMELINE…………………………………………………………………….. 10
TASK OUTLI.NE…………………………………………………………….. 13
PROJECT OUTLINE………………………………………………………… 16
SUMMARY OF RESULTS………………………………………………….. 19
SUCCESSES/FAILURES/FOLLOW-UPS………………………………... 20
PROJECT PRESENTATION………………………………………………. 21
FORMS AND TOOLS……………………………………………………… 46
ASSESSMENTS……………………………………………………………. 51
ACKNOWLEDGEMENTS…………………………………………………. 53

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December 3, 2018
Mr. Patrick Archbold et. al
Medical Reimbursement, Inc.
4460 Lake Forest Drive, Suite 216
Cincinnati, OH 45242

RE: Practicum Project A/R Medical Billing and Reimbursement

Mr. Patrick Archbold,

Thank you for agreeing to give me the opportunity to participate in my professional

practicum at Medical Reimbursement, Inc. The experience I received from you and your
knowledgeable and experienced staff will provide me with valuable resources in the
area of Accounts Receivables regarding the Healthcare Revenue Cycle.

I have gained a wealth of knowledge that I will take with me to my next endeavor in
Health Information Management, whether to further my education or to enter a different
career path in this profession.

My goal was not only to attain the needed requirements for the practicum experience
but to provide a purposeful and supportive addition to your already professional and
industrious team. I hope I had accomplished this effort and provided you with some
quality assistance to lighten the abundance of work that your work force is given on a
regular basis.

Again, thank you and your staff for such a boundless opportunity.

Sincerely,

Karen A. Bolin
enc.

Patrick Archbold: ______________________________

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 Practicum Site Overview

Medical Reimbursement Inc. was established in 1988, headquartered in Cincinnati,

Ohio and is a physician owned provider of billing and receivables management service,
coding, billing and collections services for hospital-based providers. MRI provides
services in the management of the healthcare revenue cycle for medical practices,
hospital emergency services, urgent care providers, as well as ambulatory care
services.
MRI also provides other services such as third-party contract negotiation, fee schedule
development and maintenance assistance.
It currently manages over 1.5 million provider visits for group practices, academic
medical centers and free-standing facilities throughout the United States.

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 Karen A. Bollin
Medical Reimbursements Inc.
4460 Lake Forest Drive, Suite 216
Cincinnati, OH 45242

A/R - Medical Billing and Reimbursement

Goal Statement

The goal of the project is to learn the process of the revenue cycle in a
corporate setting. This will be accomplished by assisting the Medical
Reimbursement Inc. staff in performing day to day activities regarding
medical insurance claims. This is a continuous task that will not be
completed during my internship at the facility. The goal is to help process
as many insurance edits to help facilitate the process and bring the edits to
a current status.

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 Karen A. Bollin
Medical Reimbursements Inc.
4460 Lake Forest Drive, Suite 216
Cincinnati, OH 45242

A/R - Medical Billing and Reimbursement

Project Scope
 The scope of the project is to edit as many Medicaid insurance claims to bring
them up to date

 Enter and edit patient data set, demographic registration, make sure patient is the
guarantor. Enter demographics, type of insurance, group number , policy number,
medical record number, hospital account number and date of service

 Claims should be categorized either as regular medical insurance, Workers

compensation or through auto insurance from an accident

 Enter charging information diagnosis codes, procedure codes, the time of service
make sure the medical record number is entered correctly, the hospital record is
entered correctly

 Review and edit Insurance Difference Report to correct insurance used if it has
been changed for Medicaid patients

 Ensure eligibility for Medicaid patients using Ohio MITS (Medicaid Information
Technology System)

 Research, review and edit insurance eligibility changes for Medicaid patients’
insurance accordingly

 Enter and correct the necessary edits to Medicaid patients’ insurance according to
eligibility on Ohio MITS

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 Karen A. Bollin
Medical Reimbursements Inc.
4460 Lake Forest Drive, Suite 216
Cincinnati, OH 45242

A/R – Medical Billing and Reimbursement

List of Deliverables

The deliverables of the project are as follows: Patient Registration

processing

 Guarantor information processing

 Charge Entry

 Electronic and paper claims review from scanned documentation

 Processing and documentation of correspondence

 Self-Pay follow-up and editing

 Sophisticated monthly reporting

 Mailed patient invoices

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 Karen A. Bollin
Medical Reimbursements Inc.
4460 Lake Forest Drive, Suite 216
Cincinnati, OH 45242

A/R - Medical Billing and Reimbursement

List of Resources

Resources used for this project are as follows:

 Computer

 Data entry instructions

 Printer

 GE Centricity Software

 OHIO MITS Website

 Site Managers ( Health Information Professionals)

 Registration patient Face Sheets

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 Karen A. Bollin
Medical Reimbursements Inc.
4460 Lake Forest Drive, Suite 216
Cincinnati, OH 45242

A/R – Medical Billing and Reimbursement

Risks
The risks of the project are as follows:

• Incorrect entry of patient information

• Improper entry of patient guarantor information

• Incorrect entry of claims information

• Coding information is not correct

• Billing time is not correctly entered

• Claims are denied

• Claims are not processed within the allotted time frames per type of
insurance

• Patient does not send in the correct insurance information

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 Karen A. Bollin
Medical Reimbursements Inc.
4460 Lake Forest Drive, Suite 216
Cincinnati, OH 45242

A/R - Medical Billing and Reimbursement

Timeline
The timeline of the project is as follows:

October 12, 2018 - Received practicum site and supervisor contact

October 15, 2018 – Met with Patrick Archbold and Dawn Proctor

October 31, 2018 – Began practicum project at 8:30 am. Observed scanning
process of audit journal sheets. Observed staff work processes. Received instruction how
to enter patient account and insurance information

November 1, 2018 – Entered and corrected patient/guarantor information from

registration face sheets in test data base region in GE Centricity software program.
Practice with working with patient face sheets from previous years.

November 2, 2018 – Received patient face sheets with new insurance billing and ICD 9
codes in practice mode. Entered charging information in patient insurance data. Entered
provider information, hospital code, date of service, diagnosis and procedure codes, time
for billing areas, medical record number and hospital account number.

November 5, 2018 – Practiced in test database region entering both tasks into the system
for time management purposes

November 7, 2018 – Met with Marlene Vortkamp to discuss new assignment. Read and
abstract insurance information from and Insurance Difference Report. (DIFF Report) Also
learned the editing process to remove old insurance and enter new insurance information
for Medicaid patients and those patients without insurance that were self-payers

November 8, 2018 - Continued Diff Report process. Learned to query with insurance
eligibility tasks in work ques for Miami Valley Hospital in Task Management link in
Centricity software. Account Receivables for Medicaid patients. Learned how to perform
insurance eligibility checks for Ohio Medicaid recipients on the OHIO MITS (Ohio
Medicaid Insurance Technology System) Moved patient status to pending and entered
notes in patient account. The query was 388 patients

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 Karen A. Bollin
Medical Reimbursements Inc.
4460 Lake Forest Drive, Suite 216
Cincinnati, OH 45242

A/R - Medical Billing and Reimbursement

Timeline

November 9, 2018 – Met with Caitlyn Butler to learn and go over how to make the
corrections in the system to add new insurance information to the patient and add notes
to the system. Also, met with Marlene Vortkamp to learn a new task to query a Claim Edit
List Report for a New York Practice

November 12, 2018 – Continued to work on the Claim Edit List

November 14, 2018 – Queried Task Management Report for October 2018. Also, learned
how to query and remove patients who do not have a balance on their account from the
Customer Service Review Report

November 15, 2018 – Met with Caitlyn to work on new Accounts Receivables A/R List for
Miami Valley Hospital for October 2018. Over 400 patients were queried. Thirty patients
had insurance changes

November 16, 2018 – Reviewed all tasks learned. Completed the query. Edited the list of
changes

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 Karen A. Bollin
Medical Reimbursements Inc.
4460 Lake Forest Drive, Suite 216
Cincinnati, OH 45242

A/R - Medical Billing and Reimbursement

Timeline

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 Karen A. Bollin
Medical Reimbursements Inc.
4460 Lake Forest Drive, Suite 216
Cincinnati, OH 45242

A/R - Medical Billing for Reimbursement

Tasks
10/12/18 - Received Practicum Site and Supervisor Contact

 Contacted Patrick Archbold

a. Discussed a time to meet with him and Dawn Proctor
b. Sent resume to Patrick Archbold

10/15/18- Met with Patrick Archbold and Dawn Proctor

 Discussed start date and information about the company.

Project 10/31/18 - 11/16/18 8:00 am to 4:30 pm each day

 October 31, 2018

a. Review scanning process and audit journal sheets
b. Met with Dawn to review and learn how to enter patient information
and guarantor information from the Registration Face Sheet

c. Learned how to enter patient/guarantor information using GE

Centricity Software

 November 1, 2018

a. Entered and corrected patient/guarantor information from

registration face sheet in Test database region

 November 2, 2018

 Received patient face sheet with new insurance billing and ICD 9 codes
for practice purposes, used patient face sheet information from previous
years..

 In Test Database region for several patient accounts

a. Entered charging information in patient insurance data.
b. Entered provider information

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 c. Enter hospital code
d. Entered date of service
e. Entered diagnosis and procedure codes
f. Entered time for billing area
g. Entered medical record number
h. Entered hospital account number

 November 5, 2018

Practiced in Test Database region putting both procedures into the system for time
management purposes

 November 7, 2018

a. Met with Marlene Vortkamp to discuss new assignment.

a. Learned how to read and abstract new insurance information from an
Insurance Difference Report (Diff Report).
b. Learn to edit old insurance information and entered new insurance
information for patients that had no insurance or Medicaid patients.
c. Updated only primary insurance on the Diff Report.

 November 8, 2018

a. Continued working on Diff Report

b. Observed credentialing process
c. Learned how to query and work insurance eligibility tasks in Work Ques in Task
Management on Centricity Software for the month of September 2018. The
query was 388 patients
d. Accounts Receivables (A/R) for those patients who had Medicaid ZWOH for
Miami Valley Hospital.
e. Checked for ineligibility on OH MITS (Ohio Medicaid Insurance Technology
Systems)
f. Moved patients on query to pending

 November 9, 2018

a. Continued to work the list until complete

b. Met with Caitlyn Butler to learn and go over how to make the corrections in
the system to add new insurance information to the patient and add notes to
the system

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 c. Met with Marlene Vortkamp to learn a new task to query Claim Edit List
Report for a New York Practice.
1. Claims are spooled
2. Review problems
3. Edit and correct them

 November 12, 2018

Continued to work on the Claim Edit List Report For New York Practice

 November 14, 2018

Query Task Management Report for the month of October 2018

New Insurance Difference Report to review
Learn how to query and remove patients who do not have a balance on their account
from the Customer Service Reviews

 November 15, 2018

Met with Caitlyn to work a new list for Accounts Receivables (A/R) for those patients
who had Medicaid ZWOH for Miami Valley Hospital for the month of October 2018

 November 16, 2018

Reviewed all tasks learned and completed the query and edited the list for the month
of October

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 Karen A. Bollin
Medical Reimbursements Inc.
4460 Lake Forest Drive, Suite 216
Cincinnati, OH 45242

A/R - Medical Billing and Reimbursement

Project Progress Report

Date of Progress Report: For the week of October 31 - November 2, 2018

Began practicum project at 8:30 am

Observed scanning process of audit journal sheets.

Learned how to us GE Centricity software to enter patient, account and insurance

information in test database region

Practice with working with patient face sheets from previous years

Entered and corrected patient/guarantor information from registration face sheets in test
data base region in GE Centricity software program

Received patient face sheets with new insurance billing and ICD 9 codes in practice mode

Entered charging information in patient insurance data. Entered provider information,

hospital code, date of service, diagnosis and procedure codes, time for billing areas,
medical record number and hospital account number

Practiced in test database region entering both tasks into the system for time
management purposes

Met with Marlene Vortkamp to discuss new assignment. Read and abstract insurance
information from and Insurance Difference Report. (DIFF Report) Also learned the editing
process to remove old insurance and enter new insurance information for Medicaid
patients and those patients without insurance that were self-payers

Continued Diff Report process. Learned to query with insurance eligibility tasks in work
ques for Miami Valley Hospital in Task Management link in Centricity software. Account
Receivables for Medicaid patients. Learned how to perform insurance eligibility checks
for Ohio Medicaid recipients on the OHIO MITS (Ohio Medicaid Insurance Technology
System)

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 Karen A. Bollin
Medical Reimbursements Inc.
4460 Lake Forest Drive, Suite 216
Cincinnati, OH 45242

A/R - Medical Billing and Reimbursement

Project Progress Report

Date of Progress Report: For the week of November 5 - November 9, 2018

Began practicum project at 8:00 am to 4:30 pm

Practiced in test database region entering both tasks into the system for time
management purposes

Read and abstracted insurance information from and Insurance Difference Report

Edited and removed old insurance and enter new insurance information for Medicaid
patients and those patients without insurance that were self-payers.

Continued Diff Report process. Observed credentialing process

Queried insurance eligibility tasks in work ques for Miami Valley Hospital in Task
Management link in Centricity software

Account Receivables for Medicaid patients

Performed insurance eligibility checks for Ohio Medicaid recipients on the OHIO MITS
(Ohio Medicaid Insurance Technology System)

Moved patient status to pending and entered notes in patient account. The query was
388 patients

Made corrections in the system to add new insurance information to the patient and add
notes to the system

Queried a Claim Edit List Report for a New York Practice

Met with Marlene Vortkamp to learn a new task to query a Claim Edit List Report for a
New York Practice.

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 Karen A. Bollin
Medical Reimbursements Inc.
4460 Lake Forest Drive, Suite 216
Cincinnati, OH 45242

A/R - Medical Billing and Reimbursement

Project Progress Report

Date of Progress Report: For the week of November 12 - November 16, 2018

Met with Caitlyn Butler to learn and go over how to make the corrections in the system to
add new insurance information to the patient and add notes to the system

Continued to work on the Claim Edit List

Queried Task Management Report for October 2018. Also, learned how to query and
remove patients who do not have a balance on their account from the Customer Service
Review Report

Met with Caitlyn to work on new Accounts Receivables A/R List for Miami Valley Hospital
for October 2018

Over 400 patients were on the query. Thirty patients had insurance changes
Reviewed all tasks learned. Completed the query. Edited the list of changes

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 Summary of Results

 Learned more about Healthcare Revenue Cycle and what it entails

 Learned how to read Patient Registration Face Sheet and abstract pertinent
information from it

 Learned the importance entering patient information correctly

 Learned the importance of making sure insurance claims are processed in a

timely manner. Time is of the essence when processing medical insurance
claims.

 Learned the importance of current insurance information and how critical it

is to reimbursement of claims

 Completed Medicaid Insurance eligibility edits for September and October

2018

 Learned how to query, generate reports and work from them

 Learned the importance of time management

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 Successes

Was able to meet project outcomes

Was able to complete the requirements of the project on time
Goals were met to the specifications
Scope of the project was delivered
Gained a variety of knowledge regarding the Revenue Cycle

Failures
The scope of the subject of the Revenue Cycle is so vast is was not
possible to learn it in its entirety in three weeks.

Follow up to the Project

Plan to stay connected with site director and follow up on suggestions and
resources of certain processes in the organization regarding the revenue
cycle.

I plan to utilize my knowledge and the experience received during this

project to further my career in Health Information Management

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Project Overview

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Forms and Tools

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GE Centricity Group Management Software

GE Centricity® Group Management software is a brand of healthcare IT

software developed by GE Healthcare, a division of General Electric. It
includes software for independent providers claims editing, claims
monitoring and follow-up and reporting to improve reimbursement.

The software offers a comprehensive suite of functionality for a variety of

solutions for reimbursement.

Able to monitor all outstanding claims, act on them to resolve the issue
correctly for reimbursement as quickly as possible.

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Ohio Medical Insurance Technology Systems (OH MITS)

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Patient Registration Face Sheet

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Credentialing Information

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Assessments

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The Practicum Experience

Spending three weeks working in an office which was vastly and highly
functional in the Revenue Cycle, I gained more of appreciation for the
process than from a textbook. The Revenue Cycle is the bread and butter
of healthcare. If revenue is not generated to sustain independent
practitioners, hospitals, ambulatory care centers, urgent care facilities,
emergency departments, as the list continues; the quality of care would be
mediocre at best. Even though the process is complex, it sustains
healthcare services and the organizations that provide the best possible
quality of care.
What I learned….
Learned more about the Healthcare Revenue Cycle and what it involves
Learned how to read a Patient Registration Face Sheet and abstract
pertinent information from it
Learned the importance of entering patient information correctly
Learned the importance of making sure insurance claims are processed in
a timely manner. Time is of the essence when processing medical
insurance claims.
Learned the importance of current insurance information and how critical it
is to the reimbursement to the provider
Learned about Ohio Medicaid eligibility statuses
Learned how to query, generate reports and work from them in an
organized and proficient manner
Learned the importance of time management

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 Acknowledgements

Dr. Karen Lankisch, MHI, RHIA, CHDA, Instructor

Darlene Foltz, RHIA, Assistant Professor-Educator of Health Information

Systems

Patrick Archbold, Director of Operations, Medical Reimbursement, Inc.

Dawn Proctor, Billing Production Manager at Medical Reimbursement Inc

Marlene Vortkamp, Medical Billing Manager at Medical Reimbursement Inc

Caitlyn Butler, Account Representative, Medical Reimbursement, Inc.

Lisa Story, Credentialing Coordinator, Medical Reimbursement, Inc.

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