Double trouble.Two young twins undergo tonsillectomy and adenoidectomy Tonsillectomy and Adenoidectomy Definition Tonsillectomy and adenoidectomy (T & A) are surgical procedures to remove the tonsils from the back of the mouth or adenoids from the back of the nasal cavity—both are are part of the lymphatic performed by the same provider on the same day at the same facility. The two insurance claims are filed in an identical manner. However, the twins are covered by two insurance policies because their parents have their own separate health coverage at work. Inexplicably in·ex·pli·ca·ble adj. Difficult or impossible to explain or account for. in·ex  pli·ca·bil , the first insurance on twin #1 reimburses $7.49 and the second insurance reimburses $0.21, for a total of $7.70. For twin #2, the same first insurance reimburses $322.49 and the same second insurance pays $35.81, for a total of $358.30. There is no indication on the explanation of benefits form as to whether the unpaid amount on twin #1 is a deductible That which may be taken away or subtracted. In taxation, an item that may be subtracted from gross income or adjusted gross income in determining taxable income (e.g., interest expenses, charitable contributions, certain taxes). or a write-off Write-OffA reduction in the value of an asset or earnings by the amount of an expense or loss. Companies are able to write off certain expenses that are required to run the business, or have been incurred in the operation of the business and detract from retained revenues. . How does your software system handle this vague information? This reimbursement Reimbursement Payment made to someone for out-of-pocket expenses has incurred. problem might be overlooked unless you have a system that alerts you to payments that fall far below the expected amount. Your software should alert you to such problems. In this example, if the otolaryngologist has the appropriate software, it will immediately recognize the reimbursement problem and assign it to a "hold status" work file for further action. It is possible that the physician or a staff member would notice this problem incidentally, but it is better to use information technology to monitor this and other problems. If you believe that the example cited here is a rare occurrence, you are probably mistaken. Beware--without software monitors and checks and balances, you may not be receiving minimal reimbursements that you are owed. Steven F. Isenberg, MD Dr. Isenberg is an otolaryngologist in private in Indianapolis; sisenberg@good4docs Short for documents or documentation. .com |
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