Question

1) what needs to complete differently on a CMS 1500 form in the case of a Workers' comp claim? Refer to the CMS 1500 form? Why would this be important to the claim process? Communicate your thoughts in complete sentences with appropriate grammar, punctuation and spelling.

2) When a patient makes an appointment for an injury that could have occurred on the job, the scheduled asks whether the visit is work related. If the answer is yes, what other information should the insurance specialist collect? Please communicate your thoughts in complete sentences with appropriate grammar, punctuation and spelling.

3) Determination is a part of the claims adjudication process. What are the three outcomes or determinations that are made for a claim?

4) Explain what an aging report is and how an insurance specialist would use it?

Answer 1

1) The insurance coverage for the injuries happening while on job is known as the Workers' compensation claim.

The process of invoicing involves

• Claim filing
• Therapy for patient
• Acting on the claim.

In the second phase, that is, during patient therapy,employees submit CMS -1500 claim form for compensation.There is an area in CMS-1500 form space, which gives an exact idea for physicians and suppliers whether employees have any other health insurance.If so,this will be checked by Medicare Administrative Contractor to find out either the patient's other insurance should be billed before Medicare payment or, it should be forwarded to the other insurer,if the provider, whom the medicare patient consulted, is a physician or supplier who works with Medicare.