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Ch 17

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Ch 17

  1. 1. Ch. 17Preparing Insurance Claims and Posting Insurance Payments
  2. 2.  Standard form used in medical officesCMS-1500 Form
  3. 3.  Electronic filing ◦ Electronic data interchange & standards ◦ Clearinghouses ensure claims are complete and correctly formatted Filing paper claims ◦ Used in limited situationsFiling Claims
  4. 4.  Method of monitoring outstanding claims Electronic claims tracking ◦ Available with most practice management software Claims follow-up ◦ Electronically-submitted claims: after 3 weeks ◦ Paper claims: after 6 weeksClaims Tracking
  5. 5.  Insurance payments are applied to a patient’s account, with any appropriate adjustment ◦ Payments are detailed on an EOB or RAInsurance Payments
  6. 6.  Secondary insurance is more common today with dual income earners in households Once payment is received from primary insurance, a new claim is created for secondary insurance ◦ Secondary insurance often pays the balance Attach a copy of the primary insurance EOB to the claimBilling Secondary Insurance