Eligibility, Payment and Billing Process wk 3 ckpnt 1

Eligibility, Payment and Billing Process wk 3 ckpnt 1 -...

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There are several different factors that determine the patient’s eligibility for benefits. One factor is if it is a government sponsored plan, such as Medicaid, in which the patient’s income is criterion, and their eligibility can change from month to month. Depending on which type of insurance the patient has, the medical insurance specialist may have to check eligibility for specific benefits such as lab coverage, diagnostic x-rays, maternity coverage, Pap smear coverage, and office visits. Some insurance plans do not cover preventive care, such as an annual physical examination. Most patients are willing to pay for these exams because they feel it is important to have these types of exams performed annually. If the patients insurance company does not pay for a planned service, the medical insurance specialist needs to speak to the patient directly and explain this to them so that there is no misunderstanding when a bill arrives in the mail. The patient should already be somewhat
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Unformatted text preview: familiar with what exactly his/her insurance will and will not cover. There are some payers that require some physicians to use a specific form that tells the patient about the uncovered services. These forms are called a finical agreement forms and the patients have to sign and date them. This is proof that the patient has been informed about the uncovered charges and it is their responsibility to pay for these services before they are performed. Some patients may be responsible for co-pays, over limit usage, excluded services and co-insurance payments. Patients often have to meet their deductible amount before receiving benefits. Throughout the entire billing and reimbursement cycle, it is extremely important that communication is open between the patient and the medical insurance spet, so that there is no misunderstanding in what is covered and what is the patients responsibility to pay....
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