Mary Jane Shew, a long term patient, has not
been paying her medical bills to your office.  Once you made contact
with her, she seemed embarrassed to confide that she had recently gone
through a divorce and lost her job at the same time.  Money is really
tight for her. Please answer the following in your discussion:

  • If a patient is not able to pay due to financial challenges, what
    can you do to work with this patient in order to eventually obtain
  • What are the laws governing how you can collect the debt? 
  • What information would you include in a payment agreement?
  • What process would you take if the insurance company is not paying
    timely and each time you call to check on claims-you are told that the
    claim is not on file?
  • What would you do?
  • How would you effectively communicate with the patient in a sensitive manner that there is a problem and you need their help?

You have made it!  Now let?s talk about the process. Comment on the
following points as if you are providing an overview for a potential
employer of the Learning Plans you were involved in during this course.
Please include the following:

  • The most common billing forms used in different settings.
  • In a few coding exercises, you noticed that quantity or units of
    services came into play. How can the misdocumentation of quantity effect
    the reimbursement to the provider and amount out of pocket for the
  • Is there ever a time when billing should be delayed? 
  • Remember the scenario where the ICD-10 implementation was days away
    and the office had not filed claims as their biller was on maternity
    • What could be the impact if that happened continually?
    • Could it impact timely filing limits and possibly limit payment?
    • Explain the process of resubmitting claims that maybe denied due to this. 
    • What role could the State Insurance Commissioner play in order to help get the claims paid?
    • When filing Michael Woods-did you come across a coordination of benefits (COB) scenario? 
    • Further explain what that is.  What is the difference between a primary, secondary and tertiary insurance plan?
    • Explain the difference between electronic filing and what type of reports do you get back immediately for confirmation? 
    • What is optical scanning? 
    • Where does it fit into the process? 
    • Is it best to use a clearinghouse or bill in house? 
    • Does the size of the practice make a difference? 
    • What is a charge master? 
    • In which setting is it used? 
    • Does the place of service where services were rendered play a role in reimbursement levels? 
    • Is it less expensive to have surgery in an ambulatory surgical center then in a hospital? 
    • Have you had an experience with one or the other and found that one is less costly with copays, deductibles, etc.?

Please not long answer, a hlaf of paragraph will do or a lil bit more

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