Tiêu đề MB2 Notes Complete Course..pdf ✅

Ecom Assets Medical Billing Terminology 1. Healthcare Insurance Basics  Premium – Regular payment to maintain insurance.  Deductible – Amount paid by the patient before insurance starts covering.  Co-Payment (Co-Pay) – Fixed amount paid at service time (e.g., $30 per doctor visit).  Coinsurance – Percentage-based cost-sharing after deductible is met (e.g., 80% Insurance, 20% Patient).  Out-of-Pocket Maximum – Once reached, insurance covers 100% of expenses. 2. Network Providers  In-Network – Lower cost; the provider has an agreement with the insurance company.  Out-of-Network – Higher cost; limited or no insurance coverage. 3. Additional Terms  Primary Care Physician (PCP) – Main doctor assigned to manage healthcare.  Exclusions & Limitations – Services not covered or restricted under a plan.
Ecom Assets Eligibility Verification  Purpose: Confirm patient insurance coverage and benefits before services.  Insurance Types: HMO, PPO, Medicare, Medicaid, Workers' Compensation. Methods:  Individual Check: One-by-one verification.  Batch Check: Multiple verifications processed together.  Call Verification: Direct confirmation via customer service.  Prior Authorization: Required for certain treatments to ensure coverage. Charge Entry  Purpose: Accurately record patient services and procedures for claim generation.  Key Steps:  Information Gathering: Document services, tests, and treatments.  Code Assignment: Use CPT, HCPCS, and ICD codes.  Data Entry & Validation: Enter and check information for errors.  Review & Approval: Supervisory check before claim generation.  Claim Submission: Send claims to insurers for reimbursement.
Ecom Assets Denial Management  Purpose: Address and resolve rejected insurance claims Workflow:  Claim Processing: Automated checks and eligibility confirmation.  Adjudication & Scrubbing: Verify claim accuracy and remove errors.  Denial Reasons: Often due to coding errors, missing info, or policy limits.  Appeals Process: Challenge and resubmit denied claims with proper documentation.  Accounts Receivable (AR): Monitor unpaid claims and patient balances. Denial Management  Purpose: Record and reconcile payments from insurers and patients. Key Steps:  Receive EOB/RA: Review Explanation of Benefits or Remittance Advice.  Review & Match: Ensure payment details align with submitted claims.  Adjustments: Apply write-offs or discounts as per contracts.  Posting Payments: Update patient accounts accordingly.  Reconciliation & Reporting: Maintain accurate financial records.