Question

Need it in ( Paragraph) (150 Words) includes reference plz.

Courses DISCUSSION TOPIC: All diagnoses that are submitted on an insurance claim must have supporting documentation in the medical record. Calendar Inbox What is meant by the term "supporting documentation?" Help . Who is responsible for providing supporting documentation? . Why is supporting documentation important in the completion of an insurance claim? As a part of your discussion, identify the problems that might arise from submitting claims that lack proper supporting documentation. Search entries or author Unread

Answer 1

Supporting document :

Supporting documents are the documents which gives all the relevant information about agreement made with the companies, full financial statements, and all the relevant data required to be at the safest side.

Supporting document are those written documents which contains all the information related to patients diagnosis, cost of treatment , no of days in hospital, surgeries, medicines etc , it works as an evidence in claiming medical expanses according to the policy made by government, if certain supporting documents are missing or cannot be produced then there can be a problem claiming medical insurance.

Who is responsible for providing supporting document:-

All the health care professionals are responsible for providing relevant document of the patient to the insurer for claiming medical insurance, when certain documents are needed or asked to present, its the responsibility of health professionals to fill relevant reimbursement form and send to the insurer ,

All the documents sent to the insurer must be written by physicians and if any form is sent back it's also the responsibility of health care professionals to correct and resubmit the form to the insurer.

Supporting documents needed at the time of medical insurance claim are:-

1. Signed insurance form signed.

2. Doctor who has adviced to get the admission, a prescription form is needed.

3. All the bill of hospital that is finalised and and also payment receipt in original.

4. All the investigation reports such as laboratory investigations and any other diagnostic investigation reports .

5. Bill of surgical procedures.

6. Bill such as medicine bill and other equipment bill used for patient.

7. Certificates if the case comes under medico legal and also if road traffic accident.

8. Discharge sheet issued by the hospital.

9. A check that is cancelled to get claimed amount in that account.

Problem arises with medical insurance claim with lack of documents.

1 . Missing relevant information such as date of dursurg, date of admission, onset date ,etc.

2. Time should be maintained in claiming, according to Medicare act it should be started within 12 months to claim the insurance.

3. Irrelevant patient's information such as his / her Name , date of birth, sex , policy number, code of diagnosis etc.

4. The diagnosis made by the Physician should be according to DSM CRITERIA or ICD , if it doesn't meet with the documents related to the these criteria then the claim cannot be initiated.