Understanding Health Insurance: A Guide to Billing and Reimbursement
14th Edition
ISBN: 9781337679480
Author: GREEN
Publisher: Cengage
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The difference between a remittance advice (RA) and an explanation of benefits (EOB) is:
The RA goes to the provider only and includes payment information.
The EOB goes to the provider.
The RA is sent to the patient and includes payment information.
The EOB contains payment information.
A physician asks the medical biller to change the date of service on a Medicare claim because it has passed the timely filing limit and was not previously submitted for payment. Is this fraud or abuse if the claim is then submitted? Why?
Summarize the steps a claim must go through in order to be processed and payment received for healthcare
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- Describe how health insurance participation may or may not contribute to a denial and how can it be communicated with the insurance company when filing an appeal.arrow_forwardTrue or false: People less than age 40 use the majority of long-term care services in the United States.arrow_forwardTrue or false: Home health care is considered an institutional service.arrow_forward
- Describe the projected financial impact the Affordable Care Act (ACA) will have on Medicare spending. Identify the projected financial impact(s) on how the ACA will affect Medicare spending. Be specific on how those impact(s) are projected to change health care and its delivery.arrow_forwardShould the money used to care for this woman be considered when she is being helped? Do you think that legalizing euthanasia could create conflicts of interest for the patient/ or the doctor? Will people feel that they need to end their lives earlier to save money? If you were the physician, what would you do? Note: if you would pass her off to another doctor knowing he or she would do it, does this free you from you ethical obligations?arrow_forwardTo process claims accurately and effectively, billing professionals must understand how a clean claim is prepared and what issues can contribute to a dirty claim. When managing a team of billing professionals, it is important to understand how internal and external factors contribute to a smooth process vs. a rejection or denial. Summarize internal factors (within your organization/facility) that can positively or negatively influence the life cycle of a claim. Summarize external factors (outside of your organization/facility) that can positively or negatively influence the life cycle of a claim. From a leadership perspective, how can you ensure your team is effectively trained and confident in navigating internal and external challenges with claim processing? Please be sure to validate your opinions and ideas with citations and references in APA format.arrow_forward
- What are the advantages and disadvantages of long-term care insurance.arrow_forwardThe purpose of obtaining a health history in today's medical office is to: a. have a basis for all treatment given by the provider and a guide for all future treatment. b. have information for the patient's personal use. c. have something to document in the patient's medical record. O d. have information for the insurance company.arrow_forwardWhich step of medical billing process is the most important? Why?arrow_forward
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