SUBMITTING CLAIMS Flashcards
Exception to Medicare’s mandatory electronic filing rule :
o Claims submitted by beneficiaries
o Home me oxygen therapy claims
o Organizations that submit roster claims, such as
immunizations
o Organizations with less than 10 full-time employees
are submitted directly to Medicare or other third-party
payers
can be transmitted in batches or packets to the payer’s site
can also be submitted through a clearinghouse
Electronic Claim
must be printed on an official CMS-1500 form
Paper Claim
paper claims use what software to allow for optical scanning
Optical Character Recognition (OCR) red ink
What color of ink third -party payers typically do not accept since the text would not be viewable by the OCR software?
Black ink
How many days can reimbursement for paper claims take up?
up to 30 days for payment
they can create either electronic or paper claims
Practice Management Systems (PMS) & billing software
Efficient billing includes…
frequent claims submissions
What is the third -party payers have varying rules for timely
filing?
typically from 90-365 days
it is provided online in real-time
Claim status information
it allows organizations an efficient method of estimating cash flow, which supports the revenue cycle
Claim Status
received from third-party payers and clearinghouses to track claims and manage claims
Claims transmission status reports
summarizes claim details including patient, payer, and date of transmission
Batch claim report
a clearinghouse summary of the number and total amount of claims
Scrubber report
displays the status of claims as accepted or rejected
Transaction transmission summary
