Question

how the patient's insurance eligibility is coe OB) 1T-1 in the usbok, list the billing informon found on the paticn segiatio or procedure? (Tip see Pocedure 17-2 s Describe the processes fo precefication uing the paper methsod Whut does de medical assistant noed wo ? Describe the electronic clain form De crte two ways electronK claim. be subt led 9 Describe direct billing 10 Explain the role of a claims clearinghouse Il. The medical assistant obtaised precertidication for a procedare, After the procedare was completed, what are sis nems needed so neference when completing the CMS-1500 Health Insurance Claim Form 231

Answer 1

2. At the time of the appointment, what two things are copied or scanned into the computer?

a. insurance card (both front and back)
b. Government issued ID

3. Describe how the patient's eligibility is confirmed?

Calling the phone number for insurance or view on the insurance Web portal

4. The patient's billing record information is often found on the patient registration form. Using Figure 17-1 in the textbook, list the billing information found on the patient registration form?

• Insurance information
• Insurance ID number
• Group number
• subscriber
• effective date
• secondary insurance

5. What items should the medical assistant gather when using the paper method to obtain precertification for a service or procedure?

• patient health record
• precertification request form
• copy of patient insurance card
• pen

6. Describe the processes for precertification using the paper method. What does the medical assistant need to do?

• using the health record
• determine the procedure requiring precertification
• complete the form
• proofread
• fax to insurance
• file in the health record

7. Describe the electronic claim form?

CMS-1500 submitted either directly to insurance carrier or clearinghouse for review electronically

8. Describe two ways electronic claims can be submitted?

• Direct billing to the insurance company
• Clearinghouse submission

9. Describe direct billing?

The process by which an insurance carrier allows a provider to submit insurance claims directly to the carrier electronically

10. Explain the role of a claims clearinghouse?

• acts as an intermediary between the healthcare facility and the insurance company
• audit claims for completeness
• reformats them to insurance company's specifications

11. The medical assistant obtained precertification for a procedure. After the procedure was completed, what are six items needed to reference when completing the CMS-1500 Health Insurance Claim Form?

a. Patient health record
b. patient insurance card information
c. encounter form
d. insurance claim processing guidelines
e. patient registration form
f. precertification information