Medical Review Policy Matters Make no mistake, the Medical Review Policy (MRP) does matter, and it plays a key role in determining the care that is reimbursable by a payer. The MRP is an administrative and educational tool designed to help providers, physicians, and suppliers submit correct claims for payment. Medical Review Policies outline how…
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Download Support Tool Whether the item that is returned from a payer includes a payment, is electronic, or even a denial or processing toward a deductible, everything you should need to know is found in the Explanation of Benefits (EOB). This very helpful tool provides an example of an EOB with many different notes and…
Oops, your level of membership doesn’t include access to these advanced materials. They are reserved for members working directly with our OIG compliance specialists. Please reach out to the HelpDesk to learn more about accessing these materials.
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Explanation Of Benefits (EOB) and Electronic Remittance Advices (ERA) are formatted differently for each insurance carrier, but the information they provide is the same. Armed with this important information, we can properly post payments and zero pays, as well as assign patient responsibility. The EOB allows the financial department team to locate information about the…
Oops, your level of membership doesn’t include access to these advanced materials. They are reserved for members working directly with our OIG compliance specialists. Please reach out to the HelpDesk to learn more about accessing these materials.
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Sometimes when we attend a training course, the information presented may reveal areas that need improvement. Often, training leads to more questions. As this is a pre-recorded training, the learner is limited in finding answers to added questions. On this site page you will find a variety of frequent questions that our library members have…
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Download Reference Document HHS (Health and Human Services) has supplied an entire series of HIPAA related resources that address both the Privacy & Security Rule. This reference document provides a nice summary of what is expected from a healthcare entity as it relates to Security Rule compliance. Entities should periodically check the CMS website at…
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Download Reference Document There are a great deal many rumors about HIPAA and what a provider can and cannot do. This helpful reference document breaks down the facts about the Privacy Rule and eliminates the confusion caused by misinformation. Remember, there are many resources available in KMC University’s Compliance Course and online at HHS.gov. Fast…
Oops! It looks like your level of membership doesn't include access to this course. If you are interested in this type of training please reach out to your State Association to see if they are participating with KMC University.