Question

Clean Claims Worksheet Resource: Ch. 7 of Medical Insurance A Revenue Cycle Process Approach (7th ed) Part A Listed in the table below are errors that are commonly seen when filing a claim. Out of the choices below, highlight the ones that will cause a claim to be rejected or denied Simple Errors Not using prefixes for a person's name (i.e., Mr. Ms., Dr.) Incomplete service facility name, address, and identification for services rendered outside the office/home Not using hyphens, dashes, or spaces in telephone numbers Invalid ZIP codes and state abbreviations Invalid procedure codes Incomplete other payer information. This is required for all secondary claims and all primary claims that will involve a secondary payer Missing or invalid patient birth date Part B Write a 150 to 350 word responses to each of the following questions. Be clear and concise, use complete sentences, and explain your answers using specific examples Why is it important to review claims prior to submission? If a resubmission is needed, how do you determine the method to re submit 2 To complete health care claims, medical insurance specialists work constantly with numbers billing software, websites, diagnosis codes, procedure codes, fees and charges, identification numbers, preauthorization numbers, and more. Why is it important to know how to use available resources in the medical office to research or verify information? Copyright 2015 by University of Phoenix

Answer 1

Part A :-

The errors which can cause the claim to be rejected are :-

- Missing date of birth

- Incomplete service facility name ,address and identification for services rendered outside the office/home .

- Invalid ZIP codes and state abbreviations

- Invalid procedure codes

- Incomplete other payer information

Part B :-

- It is necessary to review a claim before submission because any minute mistake can cause rejection of the claim and it doubles the burden on the patient and health care provider so, it's better to once go through the aim before submission .

- THE PROVIDER CAN APPEAL THE PAYERS DECISION AND RESUBMIT THE CLAIM FOR DECISION AND RESUBMIT THE CLAIM FOR RECONSIDERATION - ATTACHING SUPPORTING DOCUMENTATION TO JUSTIFY PROCEDURE AND SERVICE PROVIDER