Reference no: EM133955626

Question

13 revenue cycles

Physician ordering

Patient registration

charge capture

Diagnoses and procedure coding

Patient Discharge processing

Billing and claims processing

Resubmitting Claims

Third party payer Reinbursment posting

Appeals process

Patient billing

Self pay reinbursment posting

Collections

Collections reinbursment posting

Why claims are denied

Procedure/service not medically necessary

Incorrect codes or incorrectly linked codes were reported.

Preexisting condition not covered or failure to obtain preauthorization

Noncovered benefit or termination of coverage

Out-of-network provider used

Lower level of care could have been provided

Bundled service or global period service is not eligible for separate payment.

Claim contained incomplete information or another insurance plan is primary.

1. Name two of the most important steps in the revenue cycle for the billing specialist and explain your choices.

2. Name the reasons for insurance denials that you believe the billing specialist is responsible for and why.

3. Discuss the downstream impact that might occur for a patient if any of the processes of this cycle are not followed.

4. Discuss the downstream impact that might occur for a provider if any of the processes of this cycle are not followed.

5. Explain the impact that might occur to the cash flow of the facility or provider if any of the processes in this cycle are not followed.