chapt 18

Question 1

When does the medical billing process aka the revenue cycle start?

Answer 1

When the pt makes an appt and is complete when payment for services has been received

Question 2

Steps for medical billing

Answer 2

• collect pt information
• Verify the pts eligibility, confirming the pts contract with the insurance company is valid
  -When the pt arrives scan both sides of the pts insurance card and the state ID

Question 3

What to do when verifying insurance

Answer 3

-Call the providers services phone number on the back of the health insurance card
- Using the provider web portal sponsored by the pts health insurance company

Question 4

What does the pt billing record contain?

Answer 4

demographic info

Question 5

what is routine when to ask a pt when they make their first appt?

Answer 5

billing information

Question 6

For established pts what should be verified at every visit?

Answer 6

Demographic and insurance information

Question 7

What steps would the medical asst take to obtain precertification?

Answer 7

-Call the providers number on the back of the insurance card or go through the web portal
- Provide the insurance company with procedures or services requested and diagnoses
-Document the outcome of the call in the pts health record, including the precertification number

Question 8

Does precertification guarantee payment of services?

Answer 8

No

Question 9

Section 1 1500 claims form

Answer 9

Carrier : includes the type of insurance plan to which the claim is being submitted, the section only includes block 1

Question 10

Section 2 1500 claims form

Answer 10

Pt and insured information : contains information about thw pt and the insured; it includes blocks 1a through 13

Question 11

Section 3 1500 claims form

Answer 11

Physician or supplier information: contains information about the provider or supplier; includes blocks 14 through 33

Question 12

Block 4…

Answer 12

Insured name

Question 13

Block 7

Answer 13

Address of policyholder and phone number

Question 14

Block 9

Answer 14

Other insurance name
(secondary insurance)

Question 15

Block 11

Answer 15

Insured’s policy, group, or FECA # (primary insurance)

Question 16

Block 11 d

Answer 16

Determine whether the pt is also covered by a secondary insurance

Question 18

Block 12

Answer 18

Signature authorizes the release of any medical or other information necessary to process or adjudicate the claim.
SOF (Signature on file)

Question 19

Block 13

Answer 19

confirm that the insured authorization of benefits form has been signed, dated, and is in the pts record. (SOF)

Question 20

Block 14

Answer 20

requires the date of current illness, injury, or pregnancy

Question 21

Block 21

Answer 21

ICD-10-CM codes for pts condition, illness, or injury (max of 12 diagnostic codes )

Question 22

Block 24 D

Answer 22

CPT and HCPCS Code modifiers (max of per charge line)- procedure code

Question 23

Block 25

Answer 23

Rendering providers federals tax id # (EIN OR SSN)

Question 24

Block 31

Answer 24

Signature of Provider (SOF)