Medical Insurance

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Allied American University

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This paper was prepared for [INSERT COURSE NAME], [INSERT COURSE ASSIGNMENT] taught by [INSERT INSTRUCTOR’S NAME].

Module 5 Homework Assignment

PART I: BACKGROUND ASSESSMENT

Directions: Answer each of the following questions. Your responses should be 3-5 sentences in length for each question.

1. If a claim has not been paid, should you rebill? If not, what should be done instead?

2. What is an appeal, when can an appeal be filed, and what are the basic steps you should take before filing an appeal?

3. What is a “write-off,” and what are three circumstances in which it can be performed?

4. What are some inherent risks of discounting medical fees and ways to avoid these risks?

PART II: CRITICAL THINKING

Directions: Please provide responses to questions below. If necessary, please use examples or information from the textbook and/or LIRN. You may find the LIRN articles that you read in the Lecture Notes helpful. Please use proper APA citation for any resources that you use. For concise APA formatting guidelines and LIRN guidelines, please visit the Academic Resource Center (ARC). Your responses should be 1-2 paragraphs in length for each question.

1. A multiple EOB/RA comes back to a large group practice filled with details of the status of claims including a voucher (check), suspended claims, denials, and rejections for various patients and physicians. What are some steps the medical office administrator can take to record the completed transactions and address any outstanding problems?

2. How does the review and appeal process work for government and large private insurers?

3. Describe the accounts receivable administrative functions in general—what kinds of procedures need to be incorporated into the practice’s business methods and manuals?

4. A specialty practice in oncology is considering contracting with a collection agency to pursue outstanding payments due from patients. What are the key considerations in moving forward with this business decision?

PART III: LIRN ACTIVITY

After reading the LIRN article below, which was also included in the Module 5 Lecture Notes, please answer each of the following questions. Each question should have a 2 to 3 paragraph response. Remember to support your work with APA references and in-text citations. Please visit the Academic Resource Center for concise APA guidelines.

Gardner, D., & Tempest, R. (2007). The revitalization of a business office: How one system increased its self-pay collections. Healthcare Financial Management, 61(3), 80-2, 84. Retrieved from http://search.proquest.com/docview/196382832?accountid=141600

1. In the LIRN article “The revitalization of a business office: How one system increased its self-pay collections”; describe (in detail) the changes that needed to be made to retool the self-pay collections department.

2. What are some of the advantages and disadvantages of a ‘self-pay’ collections method?

3. Describe a few of the technological changes that increased financial results for the self-pay collections department at Health Alliance of Greater Cincinnati.

4. What (if any) changes would you suggest to increase positive patient relations in the self-pay collections department?

 

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