Understanding Health Insurance: A Guide to Billing and Reimbursement
14th Edition
ISBN: 9781337679480
Author: GREEN
Publisher: Cengage
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The difference between a remittance advice (RA) and an explanation of benefits (EOB) is:
The RA goes to the provider only and includes payment information.
The EOB goes to the provider.
The RA is sent to the patient and includes payment information.
The EOB contains payment information.
True or false: Nursing care is considered an institutional service.
When time is used as a key component in billing an E/M service, the provider must document face-to-face time with the patient and how much time was spent counseling the patient with the family.
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- When a patient is being admitted from home, the social worker should arrange for the medical records on the patient's last hospitalization. the facility should begin recording the patient's past history and background. prior medical records are generally not available. the social worker should obtain medical records from the admitting physician's office.arrow_forwardTo process claims accurately and effectively, billing professionals must understand how a clean claim is prepared and what issues can contribute to a dirty claim. When managing a team of billing professionals, it is important to understand how internal and external factors contribute to a smooth process vs. a rejection or denial. Summarize internal factors (within your organization/facility) that can positively or negatively influence the life cycle of a claim. Summarize external factors (outside of your organization/facility) that can positively or negatively influence the life cycle of a claim. From a leadership perspective, how can you ensure your team is effectively trained and confident in navigating internal and external challenges with claim processing? Please be sure to validate your opinions and ideas with citations and references in APA format.arrow_forwardWhy is it necessary to do a physical examination or head-to-toe assessment on a client?need help mearrow_forward
- Which billing tasks are completed before the patient visit? Insurance information is confirmed. A clean claim is submitted. Appropriate codes are assigned. Referrals are generated.arrow_forwardHow does health Insurance Portability and Accountability Act (HIPAA) facilitate electronic transactions? A Gives providers access to a centralized patient database B Gives covered providers unique identifiers to use with coding system C Allows anyone with computer access to file claims D Generates paper reports as a back up systemarrow_forwardSince medical assistants are often the patient first contact with a health care facility and the provider, what attributes, responsibilities and skills must medical assistants possess? What procedures can and cannot be delegated to the medical assistant to stay within the scope of practice?arrow_forward
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