Question

You will be responsible for completing the payment posting process for a patient in your office.

Bill Barnes was seen in your medical office on 4/13/2015 for a sick visit. While at the office, a chest x-ray and a urinalysis was completed. He pays $ 25.00 cash for his co-pay, and you submit his claim to the insurance company for payment.

You received the EOB and insurance payments from his claim submission. You are responsible for posting all payments to his ledger.

After completing the payment posting process for this patient you need to write at least a 150-word assessment on the payment policy. Explain what steps ensure accuracy of the overall process and how this relates to the overall revenue cycle management of the office. Ensure you submit both the completed ledger and word assessment to the drop box.

Answer 1

To clear the payment process of a medical billing or a health insurance claim, the hospital or clinic or health care services provider must have complete knowledge of different insurance plans that insurance companies are offering to the patients, and the payment mechanisms over them. Insurance companies can have up to different plans. Once, the provider agree to accept an insurance company's plan, the contractual agreement includes many verifications and procedures including fee payments which depict what the insurance company will pay to the hospital or health care provider and other rules such as timely filing of guidelines.

Health care providers mostly charge higher for services rather than what has been negotiated by the physician and the insurance company, so mostly the expected payment from the insurance company for services is reduced. The amount paid or reimbursed by the insurance is known as a allowable amount.

Once, the payment has been made, a provider will typically receive an Explanation of Benefits (EOB) also called Remittance Advice along with the payment from the insurance company that outlines these transactions.

The insurance payment is further reduced if the patient has a copay, deductible, or a co-insurance. In such case, the physician is then responsible for collecting the balance expense from the patient.

Various steps have also been taken to make the billing process much easier for the patients. The Health care providers are being helped to create more informative and simpler bills for their patients.