Description
In this Medical Billing Training course, you will learn the following points and much more: Parties Involved in BillingParties Involved in Medical BillingTypes of ProvidersTypes of PatientsFederal & Commercial CarriersPrimary, Secondary, Tertiary InsuranceCopay, Co-Insurance, Deductible & OOPIn -Network & OONTypes of Health Insurance plans (HMO, PPO, HDHP..)MVA, WC , Self PayMedical Billing CyclePatient Scheduling , No ShowInsurance VerificationPatient DemographyFee Schedule, Place of ServiceCharge Posting, Cross overEDI EnrollmentClearing House, Claim Submission, Electronic & PaperBilled, Allowed, Paid & Write offERA, EOB & Payment Posting, FFS, Capitation, With hold, Offset, RefundInterest Payment, Late Charges, Medical Record Payment & NSFDenial ScenariosAR AnalysisAR Follow-upCredit Balance ReviewPatient Statements & CollectionsBad DebtBankruptcyAR Days, Net Collection & Denial RateReportingDenial Analysis:1) Patient & Demographic Based Denials: Coverage / ID Problem Waiting for Additional Info from PatientInsurance Address ChangePatient Not in SystemPre-Existing Condition2) Coding based Denials: Procedure (CPT)/Diagnosis ProblemIncluded w/ Primary or Other ProcedureIncluded in Global RulesDown Coding Explanation Modifier Required 3) Payment Based Denials: Inappropriate Payment AmountMaximum Benefits Paid by Primary InsRefund Request OverpaymentsWithhold Amount4) Provider Based Denials: W9 RequestPhysician / Group Info NeededNeed Physician SignatureMedical Records NeededNot Medically Necessary5) Other Denial Categories: Insurance Needs Additional Info / Re Submit ClaimNeed Copy of EOBNeed to Contact Ins Co. for further Info Bankruptcy Letter ReceivedAttorney Requesting InformationInsurance Follow Up Scenarios: Claim not on fileClaim in processClaim PaidDenied as DuplicateClaim PendedAdditional info required from ProviderAdditional info required from PatientClaim denied for PCP ReferalDenied for authorizationDenied as Dx Code InconsistentUntimely Filing DenialProvider not available with Insurance recordThird Party PricingOONClaim paid to incorrect addressClaim Offset
