Week 5 Assignment Worksheet
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Feb 20, 2024
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MOA115 Medical Records and Insurance Week 5 Assignment –
Reimbursement Concepts Chapter 15 Medical Billing and Reimbursement Essentials A
. Types of Information Found in the Patient’s Billing Record
1.
The patient’s billing record information is often found on the patient registration form. Using Figure 15.1 in the textbook, list the billing information found on the patient registration form. ________________________________________________________________________
________________________________________________________________________ B. Managed Care Policies and Procedures 1.
What items should the medical assistant gather when using the paper method to obtain a precertification for a service or procedure? ________________________________________________________________________
________________________________________________________________________ 2.
Describe the processes for precertification using the paper method. What does the medical assistant need to do? ________________________________________________________________________
________________________________________________________________________ 3.
Describe the managed care requirements for a patient referral. ________________________________________________________________________
________________________________________________________________________ C. Submitting Claims to Third-Party Payers 1.
In your own words, identify the steps for filing a third-party claim. ________________________________________________________________________
________________________________________________________________________ D. Generating Electronic Claims 1.
Describe the electronic claim form. ________________________________________________________________________
________________________________________________________________________ 2.
Describe two ways electronic claims can be submitted. ________________________________________________________________________
________________________________________________________________________ 3.
Describe direct billing. ________________________________________________________________________
________________________________________________________________________ 4.
Explain the role of a claims clearinghouse. ________________________________________________________________________
________________________________________________________________________
MOA115 Medical Records and Insurance Week 5 Assignment –
Reimbursement Concepts E. Completing the CMS-1500 Health Insurance Claim Form 1.
The medical assistant obtained precertification for a procedure. After the procedure was completed, what are six items needed to complete the CMS-1500 Health Insurance Claim Form? a.
__________________________________________________________________ b.
__________________________________________________________________ c.
__________________________________________________________________ d.
__________________________________________________________________ e.
__________________________________________________________________ f.
__________________________________________________________________ 2.
Name the three sections of the claim form. a.
__________________________________________________________________ b.
__________________________________________________________________ c.
__________________________________________________________________ 3.
Identify information required to file a third-party claim. a.
What information must be included in Section 1 of the claim form? __________________________________________________________________
__________________________________________________________________ b.
Name 13 pieces of information required in Section 2. 1.
______________________________________________________ 2.
______________________________________________________ 3.
______________________________________________________ 4.
______________________________________________________ 5.
______________________________________________________ 6.
______________________________________________________ 7.
______________________________________________________ 8.
______________________________________________________ 9.
______________________________________________________ 10.
______________________________________________________ 11.
______________________________________________________ 12.
______________________________________________________ 13.
______________________________________________________ c.
Name 19 pieces of information required in Section 3 1.
______________________________________________________ 2.
______________________________________________________ 3.
______________________________________________________ 4.
______________________________________________________ 5.
______________________________________________________ 6.
______________________________________________________ 7.
______________________________________________________
MOA115 Medical Records and Insurance Week 5 Assignment –
Reimbursement Concepts 8.
______________________________________________________ 9.
______________________________________________________ 10.
______________________________________________________ 11.
______________________________________________________ 12.
______________________________________________________ 13.
______________________________________________________ 14.
______________________________________________________ 15.
______________________________________________________ 16.
______________________________________________________ 17.
______________________________________________________ 18.
______________________________________________________ 19.
______________________________________________________ F. Accurate Coding to Prevent Fraud and Abuse 1.
Differentiate between fraud and abuse. ________________________________________________________________________
________________________________________________________________________ 2.
What are the possible consequences of coding fraud and abuse? ________________________________________________________________________
________________________________________________________________________ G. Checking the Status of a Claim 1.
Insurance companies will typically take ______ days to process insurance claims electronically. 2.
What information is needed to verify the claim status with insurance company? ________________________________________________________________________
________________________________________________________________________
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