When a doctor sees a patient, how does the doctor’s office get paid? If a claim for a service or procedure provided is denied, how does the doctor’s office get the patient’s insurance company to pay? Handling the Medical Claim: An 8-Step Guide on "How To" Correct and Resolve Claim Issuesexplains—from beginning to end—how to bill and collect on claims for services provided in a physician’s office. Focusing on the CMS-1500 claim form, the book explains how to prepare and file the form to submit charges to patients’ insurance companies.

Written by a medical billing specialist experienced in handling medical claims and denials on both the provider and insurer sides of the business, this step-by-step guide begins by covering some basic good practice management skills. Next, it outlines each department’s specific duties based on the each department’s responsibilities for specific parts of the claim. In addition to learning how to submit and resolve claims that cannot be processed or are denied, readers will learn how to:

Enter data in the doctor’s schedule, including appointment types Gather patient data from medical records Register patients, including patient information, guarantor, and policyholder and insurance information Input information about the appointment and diagnosis Use the different types of coding systems used for billing charges Understand the claim cycle, determine reimbursement, and apply payment Obtain patient and insurance information Appeal a denied claim and handle patient balances

The book includes case examples and step-by-step guidance for resolving claim issues that could arise—including how to determine what part of the chapter you can find your answer and how to link your findings to the box number on the claim form to which the problem pertains. Highlighting opportunities for increasing revenue, it includes an overview of the revenue cycle and the importance of keeping cash flow macked with forms, charts, and illustrative examples, the text supplies the tools and understanding you’ll need to manage billing and collection in any physician’s office or clinical department.

Contents

The CMS-1500 Claim Form

Patient Data Entry (Steps 1,2, and 3)

Charge Entry (Steps 4, 5, and 6)

Accounts Receivable (Step 7)

Collections (Step 8)

Index

Author Bio

Catherine Cochran has more than sixteen years of experience in the medical office field, including front office and business office operations in small and large clinics. Her knowledge and experience ranges from patient data entry, charge entry, receipt posting, to billing and working on medical claims.

Her decision to write this book came about several years ago. Many coworkers commented that she was a good teacher and always provided help and information. As a result, she decided to pass on her knowledge and experience to new students and medical billing representat...