Handling the Medical Claim

Handling the Medical Claim

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When a doctor sees a patient, how does the doctora€™s office get paid? If a claim for a service or procedure provided is denied, how does the doctora€™s office get the patienta€™s insurance company to pay? Handling the Medical Claim: An 8-Step Guide on qHow Toq Correct and Resolve Claim Issues explainsa€”from beginning to enda€”how to bill and collect on claims for services provided in a physiciana€™s office. Focusing on the CMS-1500 claim form, the book explains how to prepare and file the form to submit charges to patientsa€™ insurance companies. Written by a medical billing specialist experienced in handling medical claims and denials on both the provider and insurer sides of the business, this step-by-step guide begins by covering some basic good practice management skills. Next, it outlines each departmenta€™s specific duties based on the each departmenta€™s responsibilities for specific parts of the claim. In addition to learning how to submit and resolve claims that cannot be processed or are denied, readers will learn how to: Enter data in the doctora€™s schedule, including appointment types Gather patient data from medical records Register patients, including patient information, guarantor, and policyholder and insurance information Input information about the appointment and diagnosis Use the different types of coding systems used for billing charges Understand the claim cycle, determine reimbursement, and apply payment Obtain patient and insurance information Appeal a denied claim and handle patient balances The book includes case examples and step-by-step guidance for resolving claim issues that could arisea€”including how to determine what part of the chapter you can find your answer and how to link your findings to the box number on the claim form to which the problem pertains. Highlighting opportunities for increasing revenue, it includes an overview of the revenue cycle and the importance of keeping cash flow moving. Packed with forms, charts, and illustrative examples, the text supplies the tools and understanding youa€™ll need to manage billing and collection in any physiciana€™s office or clinical department.SITUATION.1 CODING ERROR: ANSI CARC/RARC CODES QUESTION: Medicare is denying the service because ita#39;s an invalid code. How do you know what the correct code is? ANSWER: Check the HCPCS code book. If it is no longer aanbsp;...

Title:Handling the Medical Claim
Author:Catherine Cochran
Publisher:CRC Press - 2012-09-25


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