Some patients have two insurance coverages. One of the most common situations is when the husband or wife is covered under the plan of the other. Other times we see that a patient has Medicare and another plan. When more than one plan is in effect, we must determine which plan is the primary plan and send the bill to that plan first because the two plans will want to coordinate benefits and not duplicate payment.
Follow up is one of the most important and time-consuming activities in the office. Patients may need reminders, you may find it necessary to follow-up with insurance companies. By making the follow-up process top priority and coordinating with other daily routines, and linking it to the patient's computer records, the process can go smoothly and impact can be maximized.
Collections in the medical office/facility are usually thought of in two categories: collections from patients Or collections from insurance companies and other programs. Further, most collections occur after the date of service but some patients are required to make co-payments or other payments at the time of service. In other cases where it has been pre-determined that a patient will have a large out-of-pocket (OOP) expense after the insurance pays, some doctors require a specific commitment by the patient as to how and when the bill will be resolved.
Article - Patient signatures in a typical provider facility are usually thought of in three categories:
1- Those which are related to release of information (ROI)
2- Those related to assignment of benefits (AOB)
3- Those related to HIPAA
The typical office assistant may be involved in capturing the above, and the first and second instances above may be and usually are contained on the same document.
Prior authorization refers to the process whereby a provider tries in advance to get approval for a service that has been recommended for diagnostic or therapeutic purposes. Some carriers call it prior approval or pre-certification. Most managed care or government-sponsored carriers require that extensive or expensive procedures are reviewed before they are performed, if the provider wants to receive payment.
At the time of service, most provider facilities do not collect 100% of the amount that gets charged to their patients. Therefore, over time the accounts receivable will become past due and there must be some way of keeping track of and attempting to collect these amounts. The aging report, which is a systematic listing of how much patients owe to the doctor arranged by how long the amounts have been owed, is useful for these purposes.
Health care claims are a critical type of communication between providers (usually physicians) and payers (insurers or insurance companies) on behalf of patients. It is important to understand how medical offices prepare and transmit claims for success as a successful medical biller. Claim processing is an important task, but the technology today has made it possible to create, send and track a large volume of claims efficiently and effectively.
As a staff member in a provider facility, there are situations which arise in which the employee may ask: is this ethical? A doctor or office manager or other supervisory staff member may seek to convince the billing personnel to change codes for the purpose of gaining higher reimbursement amounts. This situation is fraud and although under the “respondeat superior” concept, the doctor is responsible for all activities in the facility, if it can be proven that the billing personnel knowingly participated, there may be kind of punishment applied, and especially if it is discovered that the employee benefited from the crime.
This regulation was initially/partially enacted in 1996. Two of the main reasons that it was needed were to more firmly establish the ability of employees to carry their insurability from one employer to the next (portability) and to more thoroughly codify situations which may be seen as violations of the privacy regulations, especially as regards the transmission of electronic information. It also mandated the use of specific formats for much of the transmission and limited the diagnostic and procedural coding sets to be used as part of the Administrative Simplification provisions. The HIPAA regulations apply to all covered entities, including health plans, health care clearinghouses, such as billing services and community health information systems, and health care providers.
These two medical billing programs are used mostly for billing for doctors professional services. The programs have many things in common, but several important differences.The most noticeable difference is the user interface: while Medisoft users will feel perfectly comfortable in a standard MS Windows environment (MS Access was used to build Medisoft), Medical Manager users will have to get used to working in the non-GUI environment, which has been enhanced to utilize help windows and other convenient tools
