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 (mlcoleman.com).

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 (mlcoleman.com). 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 (mlcoleman.com)

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 (mlcoleman.com). 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 (mlcoleman.com). In addition, billing offices should be available to provide additional guidance as questions arise with billing (mgma.com). Patient bills should be clear and concise, with the appropriate charges made and listed in great detail (St. John’s Hospital).

References

Mgma.com. MGMA In practice blog: 12 ways to improve patient billing. Retrieved from http://www.mgma.com/blog/12-ways-to-improve-patient-billing/

Mlcolemanom. Chapter 1: from patient to payment. Retrieved from  http://www.mlcoleman.com/review3/chapter1.pdf

St. John’s Hospital. Retrieved from http://www.st-johns.org/patient_info/patient_billing.aspx