Insurance Claim Filing, Essay Example

A billing workflow is designed to be an effective approach to managing different types of medical insurance claims. In the specific case of the patient with a severe cough and possible fever, the primary steps to be considered are as follows:

1)The patient arrives for his or her appointment: This step requires the patient to provide some basic information at the time of arrival, including applicable insurance benefits (

2)The patient receives the appropriate level of medical services: The physician in charge of the case evaluates the patient’s medical condition and status and determines if additional testing or evaluations are required ( During this stage, the physician should provide clear guidance to the patient at all times.

3)The insurance plan is provided with a bill for the appointment: the designated insurance plan is billed for the services rendered during the appointment (

4)The insurance plan reviews the claim and makes an appropriate response: The claim is evaluated for its validity and then a response is provided ( Insurers should be clear when addressing patients in order to obtain the most effective responses to make further decisions regarding patient services, and to also provide patients with a clear outline of their fiscal responsibility in a given situation  (St. John’s Hospital).

5) The patient receives a bill for the services rendered: The patient is provided with a bill for his or her visit ( In addition, billing offices should be available to provide additional guidance as questions arise with billing ( Patient bills should be clear and concise, with the appropriate charges made and listed in great detail (St. John’s Hospital).

References MGMA In practice blog: 12 ways to improve patient billing. Retrieved from

Mlcolemanom. Chapter 1: from patient to payment. Retrieved from

St. John’s Hospital. Retrieved from