Chapter 9 BILLING, REIMBURSEMENT, AND COLLECTIONS Billing, Reimbursement, and Collections Learning Objectives Compute charges for medical services and create patient statements based on the patient encounter form and.
Download ReportTranscript Chapter 9 BILLING, REIMBURSEMENT, AND COLLECTIONS Billing, Reimbursement, and Collections Learning Objectives Compute charges for medical services and create patient statements based on the patient encounter form and.
Slide 1
Chapter 9
BILLING,
REIMBURSEMENT,
AND COLLECTIONS
Slide 2
Billing, Reimbursement,
and Collections
Learning Objectives
Compute charges for medical services and create
patient statements based on the patient
encounter form and the physician's fee schedule.
Explain the process of completing and
transmitting insurance claims.
Discuss the advantages of using electronic claims.
Describe the different types of billing options
used by medical practices for billing patients.
Discuss the procedures and options available for
collecting delinquent accounts.
Chapter 9
2
Slide 3
Key Terms
Clearinghouse
CMS-1500 claim form
Collection agency
Collection at the time
of service
Cycle billing
Dependent
Electronic claims
EOB
ERA
Chapter 9
Fee adjustment
Fee schedule
Guarantor
Monthly billing
Patient information
form
Patient statement
Terminated account
Third-party liability
Write-off
3
Slide 4
Patient Encounter Form
Facilitates billing process
Used to record details of each patient
encounter for billing and insurance
Includes
Patient information
Date
Diagnosis for current visit
Procedure information
Financial information
Chapter 9
4
Slide 5
A N Y
Usually preprinted with common
diagnoses/procedures
New form attached to medical record
for each visit
Physician fills in form as
visit/procedures progress
Form is returned to administrative
medical assistant for use in billing
Chapter 9
o Er s t a b l i s h e d 8 3 0 3 6 A
H 1g C
b ____
Z 8558____
sc re e n _ _ _ _
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L e v e l 3D / e t a i l e d 9 9 2_ 4_ 3_ _9 3 2 2 4 H o l .t eEr K G
L e v e l 2E /x p a n d e d 9 9 2_ 4_ 2_ _ 8 3 7 1 8 H D B C h o l e s t e r o l _ _ _ _
L e v e l 1F /o c u s e d 9 9 2_ 4_ 1_ _8 5 0 1 8 H g b
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s sic r o _ _ _ _
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i dA
L e v e l 5 / C o m p . 9 9 2 1 54 _5 _3 _3 _1 F i b e r s i g m o i d o swc o/b px.y_ _ _ _
L e v e l 4D / e t a i l e d 9 9 2_ 1_ 4_ _4 5 3 3 0 F i b e r s i g m o i d o _s c_ o_ p_ y
L e v e l 3E /x p a n d e d 9 9 2_ 1_ 3_ _ 9 3 0 0 0 E K G - 1 2 l e a dW 9 3 1 0 _ _ _ _
L e v e l 2F /o c u s e d 9 9 2_ 1_ 2_ _8 0 1 6 2 D i g o _x _i n_ _
L e v e l 1M/ i n i m a l 9 9 2_ 1_ 1_ _8 2 5 6 5 C r e a t i n_i _n _e _
E s t a b l i s h ePda t i e n t 8 7 0 8 6 C o lCo n
oy
u n t_ _ _ _
8 2 4 6 5 C h o l e s t e r o l Z 8 2 4 6 _ _ _ _
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0_
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f f_ /_ _ _
L e v e l 2E /x p a n d e d 9 9 2_ 0_ 2_ _ 3 6 4 1 5 L a b H a n d l i n g F e e _ _ _ _
L e v e l 1F /o c u s e d 9 9 2_ 0_ 1_ _ G 0 0 0 1 L a b H a n d l i n gMF eed.e_ _– _ _
N e wP a tie n tF E E
D e s c rip tio n D e s c rip tio n
R e fe r r in g P h y s ic ia n _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
T r e a tin g P h y s ic ia n _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
D a te o f S e r v ic e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ L a s t D O S _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
P a tie n t N a m e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ D O B _ _ _ _ _ _ _ _ _ _ _ _ _ _
6 1 0 -5 5 5 -1 2 1 2
A n y t o w, nU S A
1 2 3 A n y S tr e e t
M E D IC A L P R A C T IC E
Patient Encounter Form
(cont’d)
5
Slide 6
Fee Schedule
Lists the usual procedures
performed in the office and
corresponding charges
There may be more than one fee schedule,
depending on insurance plan participation
Administrative medical assistant
must be familiar with office policy
regarding financial arrangements for
payment
Chapter 9
6
Slide 7
Patient Statements
All transaction data stored in patient
ledger
Statement shows
Services rendered
Charges
Payments made
Balance owed
Statement is sent to patient or
guarantor
Chapter 9
7
Slide 8
Computerized Billing
Used to print patient statements and
blank patient encounter forms
Also used to produce reports such
as
Day sheets
Monthly reports
Aging reports
Departmental income
Physician income
Procedure code usage
Chapter 9
8
Slide 9
Insurance Claims
Most practices complete the
insurance form for the patient
Form captures both clinical and
financial information
Transmitted to patient’s insurance carrier
Partial or full reimbursement
Chapter 9
9
Slide 10
The CMS-1500
Claim Form
Most common paper claim form
Prepared by medical insurance
specialist
Data is collected from
Patient information form
Patient encounter form
Transmitted via mail
Chapter 9
10
Slide 11
The HIPAA Claim Form
Standard format for electronic
claims
Accepted by government and private
carriers
Prepared on computer by medical
insurance specialist
Transmitted via a modem to insurance
company
Faster and easier to track
Chapter 9
11
Slide 12
Third-Party Payers
Insurance carriers
Review claim for accuracy and completeness
Evaluate treatment received
Decide what benefits are due to the insured
Carrier may
Pay the claim
Deny the claim
Pay less than the full amount
Chapter 9
12
Slide 13
ERA/EOB
ERA is electronic
EOB is paper
Explains reimbursement decision
Amount of benefit
Benefits paid to
Paid on behalf of
How determined
May include check or record of EFT
Chapter 9
13
Slide 14
ERA/EOB
(cont’d)
Administrative medical assistant
checks report against original claim
Files with patient’s financial records
Updates patient’s ledger
Deposits check or records EFT
Chapter 9
14
Slide 15
Patient Billing
After insurance claim process has
been completed
Patient may be billed for amounts not
fully reimbursed by the carrier
Administrative medical assistant acts
as go-between for carrier and patient
Chapter 9
15
Slide 16
Completing the
Claim Form
Verify insurance information
Use phone, fax, or Web to verify coverage
Accuracy of data
Contract numbers
Patient’s identification information
Insured’s information
Secondary carriers, if any
Illness or injury related to work or accident
Diagnosis codes
Procedure codes and charges
Provider information
Chapter 9
16
Slide 17
Using Computers
to Create Claims
Computerized billing and claims
Most practices use software programs, such as
NDCMediSoft, to store information about
patients and insurance plans
The stored information is
called a database
Claims created by billing
programs may be printed
or submitted electronically
Chapter 9
17
Slide 18
Electronic vs.
Paper Claims
Electronic claims
Paper claims
Transmitted via
modem
Receive immediate
feedback
Faster
reimbursement
Greater accuracy
Less expensive
Chapter 9
Sent through mail
Must be keyed or
scanned by insurance
company into its
computer system
Possibility of errors
18
Slide 19
Clearinghouses
Service bureau
Acts as an intermediary between provider
and payer
Reformats data from provider to a form
accepted by the payer
Chapter 9
19
Slide 20
Follow-up
ERA/EOB checked
Procedures listed on ERA/EOB match
claim
Unpaid charges explained
Codes on ERA/EOB match claim
Payment listed for each procedure is
correct
Chapter 9
20
Slide 21
Follow-up
(cont’d)
Tracer
Contains basic billing information and
asks carrier about status
Paper or electronic
Some providers automatically rebill after
30 days
Chapter 9
21
Slide 22
Follow-up
(cont’d)
Denied or late claims
Unclear denial or incorrect payment should
be followed up to determine cause
Carrier asks for more information to process
claim
Claims investigated for preexisting
conditions
Chapter 9
22
Slide 23
Follow-up
Provider resubmits claims on own
Mistake in billing
Claim overlooked
Insurance carrier asks for resubmission
(cont’d)
Incorrect codes have been submitted
Information is incomplete or missing
Charges do not total properly
Appeal process
Chapter 9
23
Slide 24
Patient
Payments
Cash flow
Payment methods
Collection at the time of service
Monthly billing
Fixed weekly or monthly payments
Bill health insurance carriers
Cash-only basis
Chapter 9
24
Slide 25
Cash Payments
Each payment is entered in
Patient’s ledger
Daily record
Payments given to assistant, not
physician
Receipt must be given
Safeguard money
Endorse checks for deposit only
Daily bank deposits
Chapter 9
25
Slide 26
Patient Statements
Monthly billing
Bills sent once a month
Timed near end of month to coincide with
patient’s other bills
Cycle billing
Avoids once-a-month billing workload
Stabilizes cash flow
Accounts divided into equal groups
Each group billed on a different date
Chapter 9
26
Slide 27
Payment Plans
and Adjustments
Payment plans
Patients unable to pay bill in one lump sum
Agreement in writing
Fee adjustment
Write-offs—PAR provider not permitted to
bill for difference between amount charged
and amount reimbursed
Physician may choose to reduce or cancel a
bill
Written evidence; don’t delete transactions
Chapter 9
27
Slide 28
Health Insurance
Provides payment for a portion of
medical expenses
Participating (PAR) providers usually file
claims for patients
Patients responsible for copayments
Non-participating (nonPAR) providers
expect payment at time of service
Receipt given to patient for payment
Patient may file claim
Chapter 9
28
Slide 29
Third-Party Liability
Person other than patient is
responsible for charges
Assistant must obtain verification from third
party
Must be in writing; can not be oral
Guarantor
Person who is the policyholder for the
patient
Dependent children
Chapter 9
29
Slide 30
Collections
Effective communication with
patients is first step in collections
process
Notify patient in advance of probable costs
not covered by insurance plans
Have patient agree in writing to pay for
noncovered services
Advance Notice for Noncovered Services
Make payment arrangements before services
are performed
Chapter 9
30
Slide 31
Collections
Collection ratio
At least 1/3 of the outstanding accounts
should be collected each day
Aging accounts
(cont’d)
Status: 30, 60, or 90 days past due
Laws regulating collections
Fair Debt Collection Practices Act of 1977
Telephone Consumer Protection Act of 1991
Chapter 9
31
Slide 32
Collections
Collection methods
Office policies
Federal laws and state laws
Telephone
Letter
Terminated accounts
(cont’d)
Physician may terminate the relationship
due to lack of payment
Collection agencies
Chapter 9
32
Slide 33
Collections
Statute of Limitations
(cont’d)
Set by each state
Truth in Lending Act of 1960
For payment plans over 4 payments in
length, with finance charges
Regulation Z requires a disclosure form to
be completed and signed by practice
manager and patient
Chapter 9
33
Slide 34
Collections
(cont’d)
Uncollectable accounts
All collection attempts have been exhausted
Would cost more to continue collection
attempts than the amount due
Written off as bad debt
Chapter 9
34
Slide 35
Quiz
Collections are made on current bills. (T/F)
False, collections are begun after the bill is more
than 30 days overdue.
An appeal is a formal method of asking for
reconsideration of a denied claim. (T/F)
True, the appeal is done in writing.
The ERA/EOB is submitted to the insurance
carrier as part of the claim. (T/F)
False, the insurance carrier uses ERA/EOB to
inform the patient/provider of the status of
claims.
Chapter 9
35
Slide 36
Critical Thinking
List some advantages of electronic
claims.
Advantages of electronic claims: lower costs,
reduced rejection, greater accuracy, faster
payment, access to status reports.
Chapter 9
36
Chapter 9
BILLING,
REIMBURSEMENT,
AND COLLECTIONS
Slide 2
Billing, Reimbursement,
and Collections
Learning Objectives
Compute charges for medical services and create
patient statements based on the patient
encounter form and the physician's fee schedule.
Explain the process of completing and
transmitting insurance claims.
Discuss the advantages of using electronic claims.
Describe the different types of billing options
used by medical practices for billing patients.
Discuss the procedures and options available for
collecting delinquent accounts.
Chapter 9
2
Slide 3
Key Terms
Clearinghouse
CMS-1500 claim form
Collection agency
Collection at the time
of service
Cycle billing
Dependent
Electronic claims
EOB
ERA
Chapter 9
Fee adjustment
Fee schedule
Guarantor
Monthly billing
Patient information
form
Patient statement
Terminated account
Third-party liability
Write-off
3
Slide 4
Patient Encounter Form
Facilitates billing process
Used to record details of each patient
encounter for billing and insurance
Includes
Patient information
Date
Diagnosis for current visit
Procedure information
Financial information
Chapter 9
4
Slide 5
A N Y
Usually preprinted with common
diagnoses/procedures
New form attached to medical record
for each visit
Physician fills in form as
visit/procedures progress
Form is returned to administrative
medical assistant for use in billing
Chapter 9
o Er s t a b l i s h e d 8 3 0 3 6 A
H 1g C
b ____
Z 8558____
sc re e n _ _ _ _
2 4 ah m
r b._ _ _ _
L e v e l 5H / i g h 9 9 2 _
4_
5 _ _ 8 7 2 1 0 K O H /W e t P re p _ _ _ _
L e v e l 4 / C o m p . 9 9 2 4 49 _3 _2 _2 _7 H o l t –e rD r . r e v i e w _ _ _ _
L e v e l 3D / e t a i l e d 9 9 2_ 4_ 3_ _9 3 2 2 4 H o l .t eEr K G
L e v e l 2E /x p a n d e d 9 9 2_ 4_ 2_ _ 8 3 7 1 8 H D B C h o l e s t e r o l _ _ _ _
L e v e l 1F /o c u s e d 9 9 2_ 4_ 1_ _8 5 0 1 8 H g b
N ew
C o n s u l t a t i o n 8 8 3 0 4 G&r o M
s sic r o _ _ _ _
8 2 9 4 7 G l u c o_ s_ e_ _
P o s t - o pV i s i t 9 9 0 _2 _4 _ _G 0 1 0 4 F i b e r s i g m –o C
i dA
L e v e l 5 / C o m p . 9 9 2 1 54 _5 _3 _3 _1 F i b e r s i g m o i d o swc o/b px.y_ _ _ _
L e v e l 4D / e t a i l e d 9 9 2_ 1_ 4_ _4 5 3 3 0 F i b e r s i g m o i d o _s c_ o_ p_ y
L e v e l 3E /x p a n d e d 9 9 2_ 1_ 3_ _ 9 3 0 0 0 E K G - 1 2 l e a dW 9 3 1 0 _ _ _ _
L e v e l 2F /o c u s e d 9 9 2_ 1_ 2_ _8 0 1 6 2 D i g o _x _i n_ _
L e v e l 1M/ i n i m a l 9 9 2_ 1_ 1_ _8 2 5 6 5 C r e a t i n_i _n _e _
E s t a b l i s h ePda t i e n t 8 7 0 8 6 C o lCo n
oy
u n t_ _ _ _
8 2 4 6 5 C h o l e s t e r o l Z 8 2 4 6 _ _ _ _
L e v e l 5H / i g h 9 9 2 _
0_
5__8054C M P ____
L e v e l 4 /C o m p .9 9 2 0 4 _ _ _ _ 8 7 0 7 C & S _ _ _ _
L e v e l 3D / e t a i l e d 9 9 2_ 0_ 3_ _ 8 5 0 2 2 C B Cd i w
f f_ /_ _ _
L e v e l 2E /x p a n d e d 9 9 2_ 0_ 2_ _ 3 6 4 1 5 L a b H a n d l i n g F e e _ _ _ _
L e v e l 1F /o c u s e d 9 9 2_ 0_ 1_ _ G 0 0 0 1 L a b H a n d l i n gMF eed.e_ _– _ _
N e wP a tie n tF E E
D e s c rip tio n D e s c rip tio n
R e fe r r in g P h y s ic ia n _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
T r e a tin g P h y s ic ia n _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
D a te o f S e r v ic e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ L a s t D O S _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
P a tie n t N a m e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ D O B _ _ _ _ _ _ _ _ _ _ _ _ _ _
6 1 0 -5 5 5 -1 2 1 2
A n y t o w, nU S A
1 2 3 A n y S tr e e t
M E D IC A L P R A C T IC E
Patient Encounter Form
(cont’d)
5
Slide 6
Fee Schedule
Lists the usual procedures
performed in the office and
corresponding charges
There may be more than one fee schedule,
depending on insurance plan participation
Administrative medical assistant
must be familiar with office policy
regarding financial arrangements for
payment
Chapter 9
6
Slide 7
Patient Statements
All transaction data stored in patient
ledger
Statement shows
Services rendered
Charges
Payments made
Balance owed
Statement is sent to patient or
guarantor
Chapter 9
7
Slide 8
Computerized Billing
Used to print patient statements and
blank patient encounter forms
Also used to produce reports such
as
Day sheets
Monthly reports
Aging reports
Departmental income
Physician income
Procedure code usage
Chapter 9
8
Slide 9
Insurance Claims
Most practices complete the
insurance form for the patient
Form captures both clinical and
financial information
Transmitted to patient’s insurance carrier
Partial or full reimbursement
Chapter 9
9
Slide 10
The CMS-1500
Claim Form
Most common paper claim form
Prepared by medical insurance
specialist
Data is collected from
Patient information form
Patient encounter form
Transmitted via mail
Chapter 9
10
Slide 11
The HIPAA Claim Form
Standard format for electronic
claims
Accepted by government and private
carriers
Prepared on computer by medical
insurance specialist
Transmitted via a modem to insurance
company
Faster and easier to track
Chapter 9
11
Slide 12
Third-Party Payers
Insurance carriers
Review claim for accuracy and completeness
Evaluate treatment received
Decide what benefits are due to the insured
Carrier may
Pay the claim
Deny the claim
Pay less than the full amount
Chapter 9
12
Slide 13
ERA/EOB
ERA is electronic
EOB is paper
Explains reimbursement decision
Amount of benefit
Benefits paid to
Paid on behalf of
How determined
May include check or record of EFT
Chapter 9
13
Slide 14
ERA/EOB
(cont’d)
Administrative medical assistant
checks report against original claim
Files with patient’s financial records
Updates patient’s ledger
Deposits check or records EFT
Chapter 9
14
Slide 15
Patient Billing
After insurance claim process has
been completed
Patient may be billed for amounts not
fully reimbursed by the carrier
Administrative medical assistant acts
as go-between for carrier and patient
Chapter 9
15
Slide 16
Completing the
Claim Form
Verify insurance information
Use phone, fax, or Web to verify coverage
Accuracy of data
Contract numbers
Patient’s identification information
Insured’s information
Secondary carriers, if any
Illness or injury related to work or accident
Diagnosis codes
Procedure codes and charges
Provider information
Chapter 9
16
Slide 17
Using Computers
to Create Claims
Computerized billing and claims
Most practices use software programs, such as
NDCMediSoft, to store information about
patients and insurance plans
The stored information is
called a database
Claims created by billing
programs may be printed
or submitted electronically
Chapter 9
17
Slide 18
Electronic vs.
Paper Claims
Electronic claims
Paper claims
Transmitted via
modem
Receive immediate
feedback
Faster
reimbursement
Greater accuracy
Less expensive
Chapter 9
Sent through mail
Must be keyed or
scanned by insurance
company into its
computer system
Possibility of errors
18
Slide 19
Clearinghouses
Service bureau
Acts as an intermediary between provider
and payer
Reformats data from provider to a form
accepted by the payer
Chapter 9
19
Slide 20
Follow-up
ERA/EOB checked
Procedures listed on ERA/EOB match
claim
Unpaid charges explained
Codes on ERA/EOB match claim
Payment listed for each procedure is
correct
Chapter 9
20
Slide 21
Follow-up
(cont’d)
Tracer
Contains basic billing information and
asks carrier about status
Paper or electronic
Some providers automatically rebill after
30 days
Chapter 9
21
Slide 22
Follow-up
(cont’d)
Denied or late claims
Unclear denial or incorrect payment should
be followed up to determine cause
Carrier asks for more information to process
claim
Claims investigated for preexisting
conditions
Chapter 9
22
Slide 23
Follow-up
Provider resubmits claims on own
Mistake in billing
Claim overlooked
Insurance carrier asks for resubmission
(cont’d)
Incorrect codes have been submitted
Information is incomplete or missing
Charges do not total properly
Appeal process
Chapter 9
23
Slide 24
Patient
Payments
Cash flow
Payment methods
Collection at the time of service
Monthly billing
Fixed weekly or monthly payments
Bill health insurance carriers
Cash-only basis
Chapter 9
24
Slide 25
Cash Payments
Each payment is entered in
Patient’s ledger
Daily record
Payments given to assistant, not
physician
Receipt must be given
Safeguard money
Endorse checks for deposit only
Daily bank deposits
Chapter 9
25
Slide 26
Patient Statements
Monthly billing
Bills sent once a month
Timed near end of month to coincide with
patient’s other bills
Cycle billing
Avoids once-a-month billing workload
Stabilizes cash flow
Accounts divided into equal groups
Each group billed on a different date
Chapter 9
26
Slide 27
Payment Plans
and Adjustments
Payment plans
Patients unable to pay bill in one lump sum
Agreement in writing
Fee adjustment
Write-offs—PAR provider not permitted to
bill for difference between amount charged
and amount reimbursed
Physician may choose to reduce or cancel a
bill
Written evidence; don’t delete transactions
Chapter 9
27
Slide 28
Health Insurance
Provides payment for a portion of
medical expenses
Participating (PAR) providers usually file
claims for patients
Patients responsible for copayments
Non-participating (nonPAR) providers
expect payment at time of service
Receipt given to patient for payment
Patient may file claim
Chapter 9
28
Slide 29
Third-Party Liability
Person other than patient is
responsible for charges
Assistant must obtain verification from third
party
Must be in writing; can not be oral
Guarantor
Person who is the policyholder for the
patient
Dependent children
Chapter 9
29
Slide 30
Collections
Effective communication with
patients is first step in collections
process
Notify patient in advance of probable costs
not covered by insurance plans
Have patient agree in writing to pay for
noncovered services
Advance Notice for Noncovered Services
Make payment arrangements before services
are performed
Chapter 9
30
Slide 31
Collections
Collection ratio
At least 1/3 of the outstanding accounts
should be collected each day
Aging accounts
(cont’d)
Status: 30, 60, or 90 days past due
Laws regulating collections
Fair Debt Collection Practices Act of 1977
Telephone Consumer Protection Act of 1991
Chapter 9
31
Slide 32
Collections
Collection methods
Office policies
Federal laws and state laws
Telephone
Letter
Terminated accounts
(cont’d)
Physician may terminate the relationship
due to lack of payment
Collection agencies
Chapter 9
32
Slide 33
Collections
Statute of Limitations
(cont’d)
Set by each state
Truth in Lending Act of 1960
For payment plans over 4 payments in
length, with finance charges
Regulation Z requires a disclosure form to
be completed and signed by practice
manager and patient
Chapter 9
33
Slide 34
Collections
(cont’d)
Uncollectable accounts
All collection attempts have been exhausted
Would cost more to continue collection
attempts than the amount due
Written off as bad debt
Chapter 9
34
Slide 35
Quiz
Collections are made on current bills. (T/F)
False, collections are begun after the bill is more
than 30 days overdue.
An appeal is a formal method of asking for
reconsideration of a denied claim. (T/F)
True, the appeal is done in writing.
The ERA/EOB is submitted to the insurance
carrier as part of the claim. (T/F)
False, the insurance carrier uses ERA/EOB to
inform the patient/provider of the status of
claims.
Chapter 9
35
Slide 36
Critical Thinking
List some advantages of electronic
claims.
Advantages of electronic claims: lower costs,
reduced rejection, greater accuracy, faster
payment, access to status reports.
Chapter 9
36