Table Of ContentC Handling the Medical Claim
Business & Management / Healthcare Financial Management & Leadership o
c
When a doctor sees a patient, how does the doctor’s office get paid? If a claim for a service or procedure provided h
is denied, how does the doctor’s office get the patient’s insurance company to pay? Handling the Medical Claim:
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An 8-Step Guide on “How To” Correct and Resolve Claim Issues explains—from beginning to end—how to a An 8-Step Guide on “How-To” Correct and Resolve Claim Issues
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bill and collect on claims for services provided in a physician’s office. Focusing on the CMS-1500 claim form, the
book explains how to prepare and file the form to submit charges to patients’ insurance companies.
Written by a medical billing specialist experienced in handling medical claims and denials on both the provider
and insurer sides of the business, this step-by-step guide begins by covering some basic good practice management
skills. Next, it outlines each department’s specific duties based on the each department’s responsibilities for specific
parts of the claim. In addition to learning how to submit and resolve claims that cannot be processed or are denied, H
readers will learn how to
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• Enter data in the doctor’s schedule, including appointment types
D
• Gather patient data from medical records
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• Register patients, including patient information, guarantor, and policyholder and insurance information
I
• Input information about the appointment and diagnosis N
• Use the different types of coding systems used for billing charges G
• Understand the claim cycle, determine reimbursement, and apply payment
T
• Obtain patient and insurance information
H
• Appeal a denied claim and handle patient balances
E
The book includes case examples and step-by-step guidance for resolving claim issues that could arise—including M
how to determine in what part of the chapter you can find your answer and how to link your findings to the box
number on the claim form to which the problem pertains. Highlighting opportunities for increasing revenue, it E
includes an overview of the revenue cycle and the importance of keeping cash flow moving. Packed with forms, D
charts, and illustrative examples, the text supplies the tools and understanding you’ll need to manage billing and I
C
collection in any physician’s office or clinical department.
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L
C
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A
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M
K12641
ISBN: 978-1-4398-5624-6
90000 Catherine Cochran
www.crcpress.com
9 781439 856246
www.productivitypress.com
K12641 cvr mech.indd 1 8/15/12 12:30 PM
Handling the Medical Claim
An 8-Step Guide on “How-To” Correct and Resolve Claim Issues
Handling the Medical Claim
An 8-Step Guide on “How-To” Correct and Resolve Claim Issues
Catherine Cochran
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2013 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20120822
International Standard Book Number-13: 978-1-4398-5625-3 (eBook - PDF)
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Contents
Acknowledgments.......................................................................................................................................................vii
Introduction.................................................................................................................................................................ix
About.the.Author.........................................................................................................................................................xi
1 The.CMS-1500.Claim.Form.................................................................................................................................1
2 Patient.Data.Entry.(Steps.1,.2,.and.3)..................................................................................................................7
3 Charge.Entry.(Steps.4,.5,.and.6)........................................................................................................................33
4 Accounts.Receivable.(Step.7)..............................................................................................................................55
5 Collections.(Step.8)............................................................................................................................................77
v
Acknowledgments
I would like to take this time to first give a special thanks to always gave me the support I needed and wanted to be one of
my husband, Rodney, and my son, Chris, for making this the first to read my book.
possible. My life has been put on hold for quite some time. Finally, I would like to thank Don Karecki, who at the time
I dedicated a lot of my time to writing this book, which was the owner and publisher of K&M Publishing, Inc., who
meant spending my weekends on the computer. Both have made this all possible. When I first began this journey, I sent
been very understanding and very supportive by pulling the out twenty to thirty letters asking if anyone would be interested
extra load. I want to say thank you and I love you both. in publishing my book; his was the only response I received. He
I wish to thank my parents for their encouragement has been with me throughout this whole process since day one.
and support. I want to give a special thank you to a couple Also many thanks go out to my senior editor with CRC
of special friends, Vickie Coleridge and Helen Jones. Both Press, Taylor & Francis Group, Kristine Mednansky, for all
of them always asked me how my book was coming along her endless patience and support throughout the past year.
and provided me with so many compliments. When I The last several months were especially rough, but she never
completed my book, they could not have been any happier gave up on me and always had a kind word.
for me. I am very grateful to the Lord above for helping me
I would like to recognize and acknowledge my boss, Lisa through some difficult times and giving me the courage to
Burcher, who helped me by letting me rearrange my work finish. He provided me with a lot of patience, good health,
schedule so I had more time to complete this book. She and pushed me when I wanted to quit.
vii
