Role of Ins Billing Specialist
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| Ability to input data & transmit insurance claims accurately directly or thru clearinghouse as well as maintain and update software applications as required by third-party payers is technical skill required of what job? | Electronic Claims Processor
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| Name some facilities where facility billing is used. | Hospitals, acute care hospitals, skilled nursing & long term care facilities, rehabilitation centers & ambulatory surgical centers.
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| Name examples of NPP's (non-physician practitioners). | Physician assistant, nurse practictioner, certified nurse anesthetist, physical therapist, speech therapist, LCSW, certified registered nurse practicioner.
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| Name 3 job titles available after training in diagnostic and procedural coding & insurance claims completion. | Insurance billing specialist
Medical Billing respresentative
Reimbursement specialist
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| Name some responsibilities & duties an ins billing rep may perform in general as well as performing collections. | Abstracts health info from patient records
Operates computer to create & transmit claims
Acts as a link between the provider & third-party payers
Insurance counselor to patients
Bills secondary insurance and patients
Updates knowledge
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| List the duties of claims assistance professional. | Help patients organize, file & negotiate health claims
Assist consumer in getting maximum benefits
Tells patients how much to pay providers to avoid overpayment.
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| Insurance claims must be submitted within how many days to ensure continuous cash flow. | 1 to 5
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| The amount of actual money available to the medical practice is known as what? | Cash flow
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| List 4 reasons for a medical practices large accounts receivable. | 1. Failure to verify insurance benefits
2. Failure to obtain authorization or pre-certification
3. Failure to collect copays and deductibles
4. Inadequate claims filing
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| Name some skills required for an insurance billing specialist. | Knowledge of medical terminology, anatomy & physiology
Expert use of procedural and diagnostic codes
Precise reading skills
Basic math
Knowledge of compliance, billing & collection techniques
Basic keyboarding & computer skills
Generate claims
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| Define medical ethics. | Standards of conduct by which an insurance billing specialist determines the propriety or his/her behavior in a relationship.
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| To report incorrect information to an Aetna insurance is what? | Unethical
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| Reporting incorrect information to a Medicare fiscal intermediary is what? | Illegal
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| In certain circumstances, if two doctors treat the same patient for the same condition it may be what? | Unethical
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| Define vicarious liability also known as respondent superior. | When a physician is legally responsible for an employee;s conduct performed during employment.
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| What type of insurance is needed if a claims assistant neglects to submit an insurance claim to a Medicare supplement insurance within the proper time limit? | Errors and omissions insurance.
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Created by:
mpeoples