unit 5 the life cycle of a claim

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University of New Orleans *

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101

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Health Science

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Feb 20, 2024

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Life Cycle of Claims Juanita Antoine Unit 5 M0205-7 General office processing Coding Department I.T Department processing Insurance companies Posting Department & Electronic deposits Following-up Department processing Patient Statements Collections

Patient Pre-Registration ▪ When patient comes in for there doctor appointment be sure to get a copy of insurance card. ▪ License( valid I.D.) and social security card. ▪ Patient must fill out all forms, leaving no questions unanswered.

Establish Financial Responsibility ▪ Inform the patient of any co-pays. ▪ Ask who will be reasonable for balance of any unpaid amount not covered by insurance. ▪ ask if there is any secondary insurance that will be used for this visit.

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Patient Check-in & Check-out ▪ Patient check-in is a process where patients check-in to begin their registration with the doctor office, by using a clipboard, are a touch screen electronic, kiosk or sometimes a self-service. ▪ Checking-in and Check-out is a function that allows the doctor to keep track of patient visits and movement throughout the office.

Superbill (Encounter Form) ▪ Pre-printed forms are used to document patients' charges, procedures codes associated with a patient visit. ▪ These forms are very important for billing the insurance companies with supporting information. ▪ Also known as a charge slip or fee ticket.

Prepare and Transmit the Claim ▪ The healthcare providers (you) prepare the insurance claims using information provided by the patient bill. ▪ The claim can be sent electronically within 4-5 days, must be submitted. ▪ Sometimes claims are done manually or sent by mail, but not recommended.

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Monitor Payer Adjudication ▪ A Monitor Adjudication once a claim reaches a payer ( insurance company or patient) then its process is called adjudication, the payer evaluates medical claims and decides if the claim is valid or compliant. ▪ At this point a claim can be accepted are denied even rejected. ▪ If accepted the payer will reimburse the provider. ▪ If rejected, may because of coding wrong. So be sure to double check your coding before submitting claims.

Generate Patient Statement ▪ You must provide all patients with a generate patient statement. ▪ Statement provide patient with any balance owe.

Follow up Payments and Collections ▪ Payments: You want to provide a patient with a follow up on balance owe within a 30-day period. ▪ Include in the follow letter services provide and cost. ▪ Collections ▪ You want to provide the patient with a date to services was given. ▪ how long the account has been delinquent ▪ A how long they have until bill will be sent to collections.

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- Reference ▪ A/R Collection: Follow Up and Collections Tech niques (firmofthefuture.com) ▪ C2. Generate Patient Statement | PracticeSuite – Help ▪ How to Generate a Superbill or Patient Statem ent | Unified Practice Help Center ( intercom.help )

unit 5 the life cycle of a claim

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