Nt1330 Unit 9 Study Guide

Once the patient comes through the door payment for services should be top of mind. All copayments and deductibles collected and any other non-covered expenses billable to the patient. The correct information is gathered and if all is handled initially properly within in the cycle the claim can go the workflow and payment received with minimum effort by human hands.

The policy states that if a patient has a copay or any other payment that needs to be made then he/she should do so at the time of their visit. This is usually done at the end of the visit encase the doctor orders any tests or lab work that might cost the patient more money. Patient’s should be informed of all or any charges and given an estimated cost.

The patient is informed about their coverage and the amount of copayment they would have to pay.

Step 3 - Financial Responsibility - Once we have established the patients co-pay or deductible we then let them know of the charges.

Prepare Claims/Check Compliance - The person that bills makes sure the claim meets the standard of compliance.

Medical billing translates a healthcare service into a billing claim. The medical biller makes appointments, transactions, and follows the claim to ensure the practice receives.

a. Pay a portion of an individual’s medical expenses according to the terms in the policy

Fee for service, as the name suggest is a method in which the healthcare provider is paid individually for each and every service provided. In this method the numbers of services determine the amount of reimbursement. This is where the healthcare providers misuse their authority and either provides more services than what is needed or just manipulate the number of services provided. There are specific

Uncompensated care is initially calculated on a clinic by clinic basis. In the annual survey charity care and bad debt are reported as charges. These two numbers are included and after that multiplied by the clinic’s expense to-charge ratio, or the ratio of total costs to gross patient and other operating income.

The deductible is the amount the member pays for services after claim have been processed by the insurance company. The insurance determines the amount that’s applied towards the members’ deductible. The amount owed depends on facts of the claim such as the type of service(s) the quantity of the service(s), and where the service took place. It could take many services like doctor’s visits, test, prescriptions refills, to meet the full deductible. The patient will receive a statement (bill) from the service provider for the amount determined by the insurance company.

The relationship between patient’s accounts, data flow, and charge capture is simple, it’s everything starting from when the patient walks in to a hospital all way up until they are discharged. First the patient will come in request services, and provide there demo-graphic. Insurance and medical information. All this information is collected for the hospitals different departments to provide correct patient care and treatment as well as charge the patient properly once treatment is completed.

Accounts receivable is money owed to a company by its debtors. The medical office has the responsibility to maximize its revenue potential by ensuring cash flow sufficiently for effective management. The overall goal is to achieve the shortest collection period possible. Account Receivable (AR) management involve almost all areas of the medical office.

When an account receivable is determined to be uncollectable it is no longer qualified as an asset and should be written off. A write off reduced the balance of the customers

Accounts receivable or A/R is a term used to denote money owed to a business by customers in exchange for services rendered but not yet collected. In medical offices, A/R refers to amounts owed by patients and their third-party payers, such as insurance companies for services provided to patients. Any payments due from patients, payers or guarantors are A/R. The overall goal of accounts receivable management is to achieve the shortest collection period possible. Offices use practice management software or a manual system to track patient accounts activity. Medical assistants enter each transaction as it occurs, then generate a report at the end of the day called "a day sheet" which is a total of all patient account transactions daily and

The fourth step is the charge entry, this is where the bill is created. An account is set up for every patient with the demographics and the account is assigned a number. While talking to B. Mcleod (personal communication, May 26, 2015) it was also stated that one of the key functions for charge