The Insurance Provider

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.

Health care plans are policies created to aid the patients in accessing medical services in form of insurance to cover the expenses incurred during treatment and hospital care. In analyzing the options given by two major health care plans elaboration will be based on two major insurance schemes namely indemnity insurance plan and Managed Care plan. All these vary yet with a common aim of providing medical services to the patients. In order for the analysis, consideration will be based on the costs and the coverage. These two plans differ in many important ways, more so in regard to how the services are offered, the way to obtain special care and the cost of care after recovery. Despite the diversities, the two care types share many

To conclude this report, there are four considerations of a legal and valid insurance contracts that patients may present at the provider’s office or clinic. The guide to understand and remember are as follows: (a) the patient or person insured must be a mentally competent adult and should not be under the influence of drugs or alcohol; (b) the insurance company must have a signed application and offer the policy to the patient, then the patient or person should accept the issuance of the policy without misrepresentation of facts on the application of the person being insured; (c) the services produced and sold or the exchange of value and the first premium payment should be submitted with the application considered must be presented together; and (d) there should be a legal purpose which is an insurable interest in the case of a person’s healthcare insurance policy. These are good guidelines to know and understand for the success of an administrative life cycle of a physician-based claim (CMS

BlueCross BlueShield Association (BCBSA) is an independent health insurance association which is founded in 1929. It is made up by 37 different health insurance organizations and companies in the United States. They directly or indirectly provide health insurance to over 100 million Americans. Under the Association, it has two famous products. One is Health Maintenance Organizations (HMOs), and the other is Preferred Provider Organization (PPOs). Most American who has health insurance from their employer are enrolled either an HMO or PPO. All of these managed care plans go through the health plan’s network, which contract with doctors, health care providers, clinics, and hospital.

To start the physician insurance claim cycle, the offices staff need to have the first encounter with the new patient. In this first encounter the office staff collect general patient information to ensure the new patient eligibility and benefits status. The Information that collect is full name, date of birth, address, insurance policy and reason of the visit. The second step the office start will verify the full benefits of the patient before the first doctor visit to make sure the patient eligibility and to stablish the patient responsibility at the time of the office visit. The day of the visit the patient complete the new patients forms and the office staff ask and make photo copy the patient insurances card and id card for purpose of

As in this world everything we want to do start with a process of steps. We started Medical billing and coding program with the first step and now we ending with a step in our last module. So is filling a medical insurance claim with an insurance company for reimbursement for services rendered by providers? This starts with a health care provider diagnosis and treating a patient for which he has to be paid or reimbursed. Filing a claim starts when a health care provider have rendered services to a patient. This process is recorded through a coder into ICD-CM 9 or 10 for diagnosis and CPT codes for the procedure/s. This communication makes up the bill. Patient demographic data and insurance information are added to the bill and a claim is ready to be processed. There are eight steps that to an accurate and expedite claim.

Medical billing in and of itself can be a complex and sensitive subject. While some patients are able to easily pay their medical bills, some have a harder time. At some point, places that offer medical care will encounter patients either unable or unwilling to pay their medical bills, and eventually these fees will need to have action taken in order to collect them. The two ways that medical facilities can choose from to collect their patients’ delinquent bills are either in-house collections or outsourced third party collection (TPC) companies. This paper will address the pros and cons of each as well as a personal recommendation as to what makes the most sense from my own point of view.

The Michigan Assisted Living Self-Insured Worker’s Compensation Fund is the only state authorized self-insured fund that was created exclusively for our profession. It sets itself apart from other worker’s compensation sources in the following ways:

"Insurance companies and other healthcare corporations responded rapidly and aggressively, developing and marketing new models of healthcare delivery. The evolution of these models, collectively referred to as managed care, is changing the American healthcare system." (Vines-Allen 53) As a health care organization entering into a managed care insurance contract is it important for not only the provider but for the medical office specialist to be familiar with all aspects of the contract. Knowing the policies and procedures for submitting claims including covered services, the appropriate claim forms and the time frame in which a claim can be submitted is essential for the medical office specialist or billing specialist to submit a correct claim and to receive full reimbursement. As we have discussed in class, the most common types of insurance payments are

Before you select a residence owner insurance carrier, take a look at a few independent research companies first. Think about the ratings each independent research firm has given the house owner insurance policy company you're considering. The most essential research findings an independent research company may offer you're the financial strengths of every residence owner insurance provider.

Over the past few decades, universal healthcare insurances offered by several governments in developed countries, particularly Western European countries, have been one of the greatest policies to deal with the challenges of tremendous expenses and unpredictable demand in healthcare services behind the principle that the insurances are practical economic plans for states to share the risk to every citizen equally and alleviate individuals from the monetary difficulties of sickness (WHO, 2002). However, inevitably, those governments have suffered the financial restrictions from the scheme. The healthcare expenditure, especially drug prescription cost has been risen by leaps and bounds, and has led to economic tension (Sinnott et al., 2013a).

The provider must consider following questions including how much risk should be accepted, any fee schedule, stop loss provision of per diem payment, agreement time period, possibility to provider make amendments, early termination requirements and so on. Especially, those factors should be very carefully considered and discussed. Furthermore, the author strongly suggests that providers really have to be aware the costs in the agreement. How gross premium comes from and what is influence the cost. The difference between provider’s cost and insurance company’s pricing is the points that provider satisfactory financial statement level. The article concludes that the profit is the difference between revenue and the cost. Therefore, careful attention must be carried on both revenues management- the author emphasizes it as an environment (insurer’s pricing, health plan contract negotiation) and cost control. Moreover, he adds up importance of understanding of contract language and responsibilities, also all of the elements making up entire relationships are equally important for further

The steps in the medical billing (revenue) cycle consists on a variety of steps. In order for the revenue cycle to function, it must flow directly and fluent. These steps must be regulated and followed in order to have sufficient revenue. One main step is to check the patient’s information such as verifying the patient’s name, birthdate, insurance number, etc., as well as making sure that everything is up to-date. Helping out patients to make an appointment is a step. Scheduling should be accurate and on time. The process of making an appointment can better be known as appointment scheduling. Checking for the insurance eligibility verification from the patient is another step to follow. Submit any claims to superior personnel. Receive and

Aetna is the healthcare policy which takes the “middle road” of the other two policies being considered. Like United Health, it is an EPO yet it comes at a significantly lesser cost. Aetna also offers a feature referred to as an “Embedded Deductible.” This is a great aspect to the policy as a plan with my husband and I as members can meet the deductible for an individual and start obtaining covered benefits sooner (Aetna, 2016). Aetna also

The administrative life cycle of a physician-based claim has several important steps that need to be followed accordingly. The first step in the life cycle starts with Patient Scheduling and Registration. The second step is Insurance Verification. Insurance verification is a very important step because when the patient comes in for his/her visit they will need to know and be prepared to either pay something or not. The third step, once the patient comes in for their visit, is Patient Co-Pay Collection. Next is Patient Exam-Documentation. Then, Order Management. After the patient visit, the next step is Coding and Charge Entry. The rest of the steps are as follows in order: Claim Checking and Error Resolution, Claim Submission, Payment Processing