Process Health Insurance Claims

 

Health insurance claims is where payment is process from your provider to your health insurance. This is why is so important to make verification first, and assure that medical insurance is cover by the provider. Claims have information such as: patient’s diagnoses, procedures, and charges. This is called claim management.

A form called Health  Insurance claim (CMS-1500) is what is use to process a claim. As I explained on other post previously, gathering the proper information is very important in order to process everything accordingly. Coding (diagnoses and procedures) which will be explained at a later post needs to be properly filled. The majority of the process now days are electronically; payments will automatically pre-fill in the system once coding is typed in the system.

One of the things an administrative assistant will be doing when creating a claim is verify, edit, and/or change the status of a claim. There will be certain step to follow up when transmitting a claim. The last thing you do once everything is confirmed is transmit the claim electronically. Supporting data (other documentation needed) verification will be necessary at time, depending on the diagnoses of the patient. You can print claims, reprint and delete claims as well.

Maintaining Health Records

Maintaining health records if one of the most important thing to do at the medical office setting. It is important to have everything accurate and in order. A health record is divided by sections for each patient. This is called a file with all the information necessary  from personal, health insurance, chief complaint, progress notes, consultation and more. This applies to electronic records and paper records.

Some medical offices have files stored in a cabinet, this means that medical records are still process on papers and they are kept in a confidential storage. No matters how is process, everything needs to be strictly confidential. They have it sort it by index order units. In the majority medical office setting they file by numeric storage systems,and others are by alphabetic storage systems. This is the information that they work with, when patients are schedule, and files records are set in a place early in the morning to have it ready when patient arrives to the office.

Electronic records have the same information as mention before; however, it is more beneficial because it can be electronically transfer to a doctor’s office.  It is more efficient storage and retrieval. It can be stored with a backup in case of a disaster so that data can be accurately safe and intact. It is paperless and has other beneficial sources.

Answering Patient’s Phone Calls

Answering phone calls is an everyday job a medical office setting has to deal with. Answer machines are available in most offices to better serve the patient, and return their calls in case the assistants are helping other callers or patients at the office. When handling a phone call, one of the things we need to keep in mind is the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Confidentiality is very important and some information cannot be discussed over the phone.

The assistants handle patient's scheduling, rescheduling, and cancellation over the phone. They need to get the proper information (name of the patient, date of birth and telephone number) to be retrieved from the system; any changes needs to be updated in the system accurately. Furthermore when a patient is ill and calls the office to request to be seeing by the doctor, the assistant takes information from the patient, and have a triage nurse return patient’s call.

Referrals are important and specific information is necessary. Most office has an answering machine where they asked the patient to provide their personal information along with the doctor’s referrals information. Patient needs to call a couple days prior the appointment date, and make the request. If any other information is needed, an assistant will call the patient on behalf of their referral request to gather more information.

Assisting Patients

Assisting patients is one of the main things I need to focus on my career. The first thing I need to assure is that they sign the log sheet as they come inside the office. The patient is called to confirm appointment or if they are a walk in for illness. I gather information from the patient; name, date of birth, address, and telephone number to pull up their data from the system. Once the information is confirmed, I get the chart and make sure everything is accurate. Patient needs to be authenticating, whether he or she is the patient or guardian person.

Consents and other necessary papers need to be sign by the patient. Every patient who comes to the office for the first time, the Health Insurance Portability and Accountability Act of 1996 (HIPPA) is provided to them, to read and sign. This document explains their privacy and how confidential information is handled.

Insurance information needs to be taking, documented, and copied if is not updated in the chart. Once everything is verified, sign, and copies are taking, they are encourage to have a seat and wait until a medical assistant person calls them to be attended.