introduction to health care careers medical office receptionist insurance billing
DESCRIPTION
An Introduction to a career in Health Care as a Medical Receptionist and Insurance BilllerTRANSCRIPT
INTRODUCTION TO HEALTH CARE CAREERS
Mary Claire Cuthbert RN, CLTC
PERCEPTION
ROAD TO NOWHERE
CAREERS IN HEALTHCARE
DO YOU THINK YOU ARE INVISIBLE?
A PIECE OF THE PUZZLE!
DETAILED
COMMUNICATE
HONEST AND ETHICAL
BE ADAPTABLE
YOU MAY HAVE TO PUT FIRES OUT
AGGRESSIVELY PATIENT
DON’T TAKE IT PERSONALLY
DOING THINGS THAT ARE IMPOSSIBLE
FOLLOW MY LEAD
ARE YOU SCARED?
TERRIFIED
WILL YOU FIND YOUR WAY?
THERE IS A WAY
CLARITY AND PURPOSE
BACK AND FRONT OFFICE
Typical medical office has two main areas: Back office Front office
Back office Also known as “clinical” area Where all examinations, diagnostic testing,
and medical procedures conducted
BACK AND FRONT OFFICE
Back office (cont’d) Typical personnel:
Health care professionals e.g., doctors, nurses, physicians assistants, medical
assistants, X-ray technicians
Even though primary focus is patient care, work closely with those in front office
Sometimes sharing responsibilities
FRONT OFFICE
Front office Also known as
administrative area Hub of medical
facility Staff play key role in
proper management of medical office
e.g., administrative medical assistants, medical transcriptionists, medical insurance billers, office managers
APPOINTMENT SCHEDULING PRINCIPLES
Front office staff usually have first contact with patients when they request appointments
Partial patient information collected over phone
THE PROCESS
Patient registration Registration information/form Encounter form
Clinical assessment and treatment Physician/Provider visit
Patient departure Scheduling and billing
PATIENT REGISTRATION
Receptionist Registers patient Obtains authorizations Copies/Scans insurance
card Generates encounter form
PATIENT REGISTRATION FORM
Demographic information Insurance information Authorization/Assignment of benefits Electronic or paper format
PATIENT REGISTRATION
Electronic health (medical) record New patient
Create patient database Enter registration information Scan insurance card
Established patient Update database
ENCOUNTER FORM
Also called charge slip, routing form, or superbill Type of visit Lab tests and treatments Diagnoses Charges, payment, and balance due Patient signature/authorization
CLINICAL ASSESSMENT AND TREATMENT
Physician/Provider
Examines patient Orders lab tests and
treatments Completes clinical sections
on encounter form
DEPARTURE PROCEDURES
Schedule another appointment If necessary
Compute charges for services Collect copayment Post charges and payments
POSTING CHARGES AND PAYMENTS
Charges:Encounter forms are “source documents”
Payments:Checks, receipts, and insurance statements
are “source documents”
Charges and Payments posted to
patient account ledger and day sheet
POSTING CHARGES AND PAYMENTS
Electronic billingCharges and payments entered into patient database
Billing Specialist
generates: Statements
Receipts
Claim forms
Transaction journals b
DIAGNOSTIC AND PROCEDURE CODES Remember Source Documents are
Encounter form Medical record
Medical coder Reviews encounter form and medical record Assigns codes Enters codes into database
INSURANCE CLAIM FORM
CMS-1500 Patient and insurance information
CMS-1500 blocks 1-13 Treatment and provider information
CMS-1500 blocks 14-33 Charges
CMS-1500 blocks 24F, 28, 29, and 30
INSURANCE CLAIM FORM
Billing specialist
Submits claim Paper
Completes claim form using source documents Electronic
Generates claim form using patient database
INSURANCE CARRIER/COMPANY
Reviews claim for errors “Clean” claim
Provider (or patient) receives payment “Dirty” (denied) claim
Payment withheld Provider and patient notified
DENIED CLAIMS
Technical (data entry) errors Missing or incorrect information Transposed numbers Incomplete codes
Coverage Service not covered by health insurance Patient not covered by policy at time of service
RESOLVING DENIED CLAIMS
Technical errors Billing specialist corrects errors Claim resubmitted
Coverage Billing specialist may contact patient Charges billed to patient
OTHER CLAIMS PROBLEMS
Delinquent or pending Payment from insurance carrier overdue Claim lost or misplaced
Billing specialist Contacts insurance company
Phone, e-mail, or written inquiry May resubmit claim
STATE INSURANCE COMMISSION
Responsibilities Monitor financial strength of insurance companies Protect interest of insured and policyholders Maintain complaint records Resolve insurance conflicts
STATE INSURANCE COMMISSION
Referrals Pattern of problems with payment for services Unresolved primary payer status conflicts
Provider or patient may submit complaint Billing specialist may assist patient