Jul 27, · Our review of the literature reveals that these aspects could be grouped under efficiency, reliability, privacy and security, and responsiveness and communication. Speed in performing E-Banking services is a determining factor of customer satisfaction according to Information on payment for copying fees can be found in the Humana PPI Medical Records Management Policy. Healthcare providers can submit requested documentation to Humana via mail, fax, upload or an electronic medical records system. For faster adjudication of claims, the requested information should be uploaded Nov 09, · November 09, Central Bank Digital Currency: A Literature Review. Francesca Carapella and Jean Flemming. Technological advances in recent years have led to a growing number of fast, electronic means of payment available to consumers for everyday transactions, raising questions for policymakers about the role of the public sector in providing a digital payment instrument for the
The Fed - Central Bank Digital Currency: A Literature Review
Humana operates literature review on electronic payment system review program to detect, prevent and correct fraud, waste and abuse and to facilitate accurate claim payments.
To further this program, Humana conducts reviews on prepayment and post-payment bases. Below you will find a description of the provider payment integrity PPI post-payment review process.
Healthcare providers may have the right to dispute results of reviews as stated in the Humana Provider Payment Integrity Medical Record Review Dispute Policy. During such reviews, the healthcare provider is asked to allow Humana access to the medical record and billing documents that support the charges billed, literature review on electronic payment system. The Treatment, Payment and Health Care Operations TPO exception under the Health Insurance Portability and Accountability Act HIPAA Privacy Rule 45 CFR Humana utilizes, but is not limited to, the resources below to conduct its reviews.
These are widely acknowledged national guidelines for billing practices and support the concept of uniform billing literature review on electronic payment system all payers. Humana PPI post-payment reviews look for overutilization of services or other practices that directly or indirectly result in unnecessary costs to the healthcare industry, including the Medicare and Medicaid programs.
Examples include, but are not limited to:. An on-site review allows a reviewer to visit a healthcare provider to review medical records and other billing documentation in person. Humana has the following on-site review guidelines:. A desk review allows the healthcare provider to submit medical record and billing documentation to Humana or its designee for the post-payment review.
The desk review process includes the following steps:. PPI will not accept disputes after 18 months from the date the claim was paid, denied or not paid by the required date or as otherwise provided by state or federal law. The time frame for nonparticipating healthcare providers is days when applicable state and federal laws are silent. If a dispute request is initiated within 75 calendar days from the date of the findings letter, literature review on electronic payment system, recoupment may be avoided until the dispute process is completed.
Healthcare providers who do not submit the requested medical record documentation may receive a technical denial until all necessary information is received. Please refer to the Humana PPI Technical Denial Policy for details and time frames for submitting necessary information.
Home Humana for Healthcare Providers Medical resources Payment integrity Post-payment reviews. Humana Provider Payment Integrity Post-payment Review Policy. Department of Health and Human Services final rules, regulations and instructions published in the Federal Register Nationally recognized, evidenced-based published literature from such sources as: UpToDate® World Health Organization Modified Framingham Criteria Academy of Nutrition and Dietetics American Society for Parenteral and Enteral Nutrition Medscape American Association for the Study of Liver Diseases Society for Healthcare Epidemiology of America Kidney Disease: Improving Global Outcomes, Clinical Practice Guideline for Acute Kidney Injury The Third International Consensus Definitions for Sepsis and Septic Shock Journal of the American Society of Nephrology JASN Humana PPI post-payment reviews look for overutilization of services or other practices that directly or indirectly result in unnecessary costs to the healthcare industry, including the Medicare and Medicaid programs.
These reviews also confirm that: The most appropriate and cost-effective services and supplies were provided. On-site reviews An on-site review allows a reviewer to visit a healthcare provider literature review on electronic payment system review medical records and other billing documentation in person.
Humana has the following on-site review guidelines: A representative for the healthcare provider may be present during the review process, literature review on electronic payment system.
Humana or its designee will notify the healthcare provider of the intent to review a claim. The healthcare provider will submit to Humana or its designee a copy of the itemized bill, if requested, within 30 days of the date requested.
This should be submitted before the review occurs. Healthcare providers are asked to respond to a scheduling request within 30 days of receipt of the request and schedule the review on a mutually agreed date and time. If a scheduled date is not confirmed by the healthcare provider within 30 days of the initial request, Humana or the designee will attempt to contact the facility via phone, email or letter. If there is still no response, two additional attempts will be made.
If Humana or its designee is still unsuccessful at scheduling a date for the onsite review after these attempts, literature review on electronic payment system, a technical denial may be issued; this may result in the claim being considered overpaid and recovery being initiated.
Once the review has been scheduled, the technical denial will be reversed, and the claim will be repaid if it has been recouped. Humana or the designee will notify healthcare providers of the review results via letter or by conducting exit conferences within 30 days from the date Humana or its designee completes the review or on an alternative agreed-upon date. The healthcare provider may have the right to dispute the results of the review.
Please refer to the Humana PPI Medical Record Review Dispute Policy. If an underpayment is identified during the review and the healthcare provider is owed payment by Humana, the healthcare provider may be asked to submit a corrected claim to receive additional reimbursement, literature review on electronic payment system. Desk reviews A desk review allows the healthcare provider to submit medical record and billing documentation to Humana or its designee for the post-payment review. The desk review process includes the following steps: Humana may conduct reviews of claim payments within 18 months of the original date of payment or such other period as may be required or allowed by applicable law, or any Humana participation agreements.
Humana may request medical records, itemized bills, invoices or other substantiating documentation to support the charges billed. Healthcare providers are asked to send copies of requested documentation within 30 days of receipt of the request.
Information on payment for copying fees can be found in the Humana PPI Medical Records Management Policy. Healthcare providers can submit requested documentation to Humana via mail, fax, literature review on electronic payment system or an electronic medical records system. For faster adjudication of claims, the requested information should be uploaded. Details on submission methods can be found in the Humana PPI Medical Records Management Policy.
In the event a healthcare provider does not submit or refuses to provide a medical record, he or she may receive a technical denial that may result in the claim being considered overpaid and recovery initiated. The Humana PPI Technical Denial Policy contains additional information. Healthcare providers may have the right to dispute results of reviews.
Those who are not in agreement with the explanation or findings should refer to the Humana PPI Medical Record Review Dispute Policy for details. Records submission Healthcare providers who do not submit the requested medical record documentation may receive a technical denial until all necessary information is received, literature review on electronic payment system.
Chat with us. How may we help? Let's chat.
How to Write a Literature Review: 3 Minute Step-by-step Guide - Scribbr ��
, time: 3:05Postpayment Review Policy, Humana Provider Payment Integrity
Information on payment for copying fees can be found in the Humana PPI Medical Records Management Policy. Healthcare providers can submit requested documentation to Humana via mail, fax, upload or an electronic medical records system. For faster adjudication of claims, the requested information should be uploaded Review their active performance and integrity information which the government may use in making an award decision Note – Contractors/Financial Assistance Recipients may view only their own data. To do so, you must be registered in the “System for Award Management” (SAM) and must have created a Marketing Partner Identification Number Materials and methods In this study/review paper, we give an overview of an electronic payment system, discuss the background history, highlight current available payments system against e-commerce, individual features of each payment system in a tabular form, highlight the security flaws, and finally identify issues, and suggest a solution
No comments:
Post a Comment