Question

loe would a mnedical biller ndeaify the reason for a rejected clains are the two main reasons for denial claims? 12 Is your own wonds, define medical necessity a define it applies to diagnostic and 3 Describe a coinsurance of 70030 ratio 14 Explain patient financial obligations for services rendered Pat N: Interpret Information on an Insurance Card 235

Answer 1

ANSWERS :

1. Rejected claims in the health care sector occur due to errors in claiming of the bills of patient. Medical biller can identify the rejected claims by following criteria -

* Identify the for any incorrect patient information, address, insurance provider information,codes all entries in the record

* Identify for any duplicate billing on patients name

* Identify for billing errors like improper or incorrect diagnosis entry of the record

* Check for the insurance company address and patients information entered correctly or not

2. Denial claims are defined as an insurance company refuses to credit or honor request of a provider for paying of health care services which were taken from health care professionals in an organization. The reasons for denial of claims are -

1. Duplicate claiming of health services

2. Missing of required patients information to claim bills

3. MEDICAL NECESSITY : Medical necessity is defined as providing of health care services to patient by health care providers like doctors for the purpose of making accurate judgement, treatment of diseases, diagnosing, identifying signs and symptoms of disease conditions.