The development of an insurance claim starts when the patient makes the call to a health care provider's office and requests an appointment. At that time, the designated administrative staff must ascertain if the person is a new patient requesting an initial appointment or an established patient returning to the practice for other additional services. The preclinical interview and check-in of a new patient is longer than that for an established patient because the established patients has already been in that facility.
NEW PATIENT INTERVIEW AND CHECK-IN PROCEDURES
1. Perform a New Patient Intake Interview.
2. Contact the insurance company to verify insurance eligibility and benefit status.
3. Schedule the patient's appointment.
4. …show more content…
Make a return appointment either at the time of the last appointment or later when patient telephones for a new appointment.
Step 2. Check the authorization status on all managed care patients.
Step 3: Check the patient's registration demographics while they are present at the front desk.
Step 4. Created the encounter form for the patient.
CHECK-OUT PROCEDURES
Step 1. Code, if necessary, all procedures and diagnoses
Step 2. Enter the charges for procedures and/or services performed and total the charges
Step 3. Post all charges to the patient record either manually or in the computer.
Step 4. Collect payment from patient.
Step 5. Post any payment to the patient's account.
Step 6. Develop the insurance claim.
Step 7. Note the completion of the claim form on the patient's ledger/ account.
Step 8. Affix any required attachments to the claim, such as copies of operative reports, pathology reports, and copies of written authorizations.
Step 9. The provider signs the claim form, if the claim is manually completed, or if special arrangements have been made with the insurance carrier the provider's name is typed or stamped.
Step 10. File a copy of the claim form and copies of the attachments in the practice's insurance …show more content…
The Explanation of Benefits form is completed. The Explanation of Benefits (EOB) form or report is a statement telling the patient or provider how the insurance company determined its share of the reimbursement. The report includes the following:
A list of all procedures and charges submitted on the claim form
A list of any procedures submitted but not considered a benefit of the policy.
A list of all the allowed charges for each covered procedure.
The amount of the patient deductible, if any, subtracted from the total allowed charges.
The patient's financial responsibility for cost-sharing for this claim.
The total amount payable by the insurance company on this claim.
Step 9. EOB and benefit check is mailed. If the claim form stated that direct payment should be made to the physician, the reimbursement check and a copy of the EOB will be mailed to the physician. This can be accomplished in one of three ways:
1. The patient signs the Authorization of Benefits Statement, Block 13 on the HCFA-1500 form.
2. The physician marks "YES" in Block 27 on the claim form.
3. The physician has signed an agreement with the insurer for direct payment of all claims. If reimbursement is to be sent to the patient, the policyholder will receive a copy of the EOB, but no explanation is sent to the
NEW PATIENT INTERVIEW AND CHECK-IN PROCEDURES
1. Perform a New Patient Intake Interview.
2. Contact the insurance company to verify insurance eligibility and benefit status.
3. Schedule the patient's appointment.
4. …show more content…
Make a return appointment either at the time of the last appointment or later when patient telephones for a new appointment.
Step 2. Check the authorization status on all managed care patients.
Step 3: Check the patient's registration demographics while they are present at the front desk.
Step 4. Created the encounter form for the patient.
CHECK-OUT PROCEDURES
Step 1. Code, if necessary, all procedures and diagnoses
Step 2. Enter the charges for procedures and/or services performed and total the charges
Step 3. Post all charges to the patient record either manually or in the computer.
Step 4. Collect payment from patient.
Step 5. Post any payment to the patient's account.
Step 6. Develop the insurance claim.
Step 7. Note the completion of the claim form on the patient's ledger/ account.
Step 8. Affix any required attachments to the claim, such as copies of operative reports, pathology reports, and copies of written authorizations.
Step 9. The provider signs the claim form, if the claim is manually completed, or if special arrangements have been made with the insurance carrier the provider's name is typed or stamped.
Step 10. File a copy of the claim form and copies of the attachments in the practice's insurance …show more content…
The Explanation of Benefits form is completed. The Explanation of Benefits (EOB) form or report is a statement telling the patient or provider how the insurance company determined its share of the reimbursement. The report includes the following:
A list of all procedures and charges submitted on the claim form
A list of any procedures submitted but not considered a benefit of the policy.
A list of all the allowed charges for each covered procedure.
The amount of the patient deductible, if any, subtracted from the total allowed charges.
The patient's financial responsibility for cost-sharing for this claim.
The total amount payable by the insurance company on this claim.
Step 9. EOB and benefit check is mailed. If the claim form stated that direct payment should be made to the physician, the reimbursement check and a copy of the EOB will be mailed to the physician. This can be accomplished in one of three ways:
1. The patient signs the Authorization of Benefits Statement, Block 13 on the HCFA-1500 form.
2. The physician marks "YES" in Block 27 on the claim form.
3. The physician has signed an agreement with the insurer for direct payment of all claims. If reimbursement is to be sent to the patient, the policyholder will receive a copy of the EOB, but no explanation is sent to the