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Explain how technology and human error may contribute to a denial by the insurance company.
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- Describe how health insurance participation may or may not contribute to a denial and how can it be communicated with the insurance company when filing an appeal.Discuss Possible legal,ethical and disciplinary implications of false documentation.A physician asks the medical biller to change the date of service on a Medicare claim because it has passed the timely filing limit and was not previously submitted for payment. Is this fraud or abuse if the claim is then submitted? Why?
- describe the difference between primary, secondary, and supplementary insurance. Do you feel having secondary and/or supplementary insurance is a benefit for the patient or more trouble than it is worth? Explain your answer.Explain the process of submitting a claimExplain the importance of written discovery in a medical-negligence case. Explain why policies and procedures are often used in litigation.
- Discuss the financial impact of initially declined claims and delayed payments to healthcare organizationsWhy do insurance companies practice things like restricting provider choice, gatekeeping, and pre-authorization?To process claims accurately and effectively, billing professionals must understand how a clean claim is prepared and what issues can contribute to a dirty claim. When managing a team of billing professionals, it is important to understand how internal and external factors contribute to a smooth process vs. a rejection or denial. Summarize internal factors (within your organization/facility) that can positively or negatively influence the life cycle of a claim. Summarize external factors (outside of your organization/facility) that can positively or negatively influence the life cycle of a claim. From a leadership perspective, how can you ensure your team is effectively trained and confident in navigating internal and external challenges with claim processing? Please be sure to validate your opinions and ideas with citations and references in APA format.
- When time is used as a key component in billing an E/M service, the provider must document face-to-face time with the patient and how much time was spent counseling the patient with the family.Which of the following tasks should be completed prior to claim submission? Coding the visit Using the UB-20 form Provider signing the claim Manually sending the claimWhat are the provisions of the False Claims Act in healthcare reimbursements?
