Role of the Insurance Billing Specialist
What are some job titles associated with med billing personnel?
billing specialist, electronic claims processor, medical biller, reimbursement specialist, medical billing representative, and senior billing representative.
E-mail, used for sending and receiving information from one person to another
Define ethics.
If a medical biller submits a fraudulent claim will they be held accountable legally?
Yes, both the employee and employer would be held liable.
What is Facility Billing?
Charging for services done in hospitals, acute care hospitals, skilled nursing or long-term care facilities, rehab centers, or ambulatory surgical centers.
define claims examiners.
the role of a claims examiner is to analyze and process incoming claims, checking them for validity and determining if the services were reasonable and necessary.
You see the secretary ignoring patients as they walk by and not greeting them. She is looking at her computer and won't make eye contact. Is this good medical etiquette?
NO. Always greet patients and make eye contact. We are there for the patient and it is our job to make them feel welcome and comfortable.
What is AMA?
American Medical Association.
What does malpractice insurance do?
Protects the company for liability from disputed services.
What is professional billing?
Charging for services performed by doctors, or non-physician practitioners.
What is an MSO?
Management Services Organization
You call into the billing center of a healthcare facility. A woman answers and says "hello". She does not identify herself. Why is this poor etiquette?
when working, always identify yourself and where you are located. Ask the patient what they need assisted with. Answering with a simple "hello" is unprofessional.
True or False.
It is legal to report incorrect information to government-funded programs such as Medicare, Medicaid, and TRICARE.
False.
It is never legal to report false information.
What is an independent contractor?
List a few examples of a non-physician practitioner.
physician assistant, nurse practitioner, advanced registered nurse practitioner, certified anesthetist, physical therapist, speech therapist, licensed social worker, certified registered nurse practitioner.
What is a CAP? What do they do?
Claims Assistance Professional
work for the consumer, help patients negotiate insurance claims and assist the patient in getting maximum benefits.
A coworker sent you an email about the upcoming meeting. He used emoticons in his message. Is this appropriate?
No, never use emoticons in the work setting in an email. This is unprofessional.
No, never belittle or make critical remarks regarding a healthcare organization.
What is Errors and omissions insurance?
What procedures are performed in the office setting?
scheduling appointments, registering patients, documenting, charge entry, bookkeeping and accounting.
Define Cash Flow.
Amount of actual money generated and available for use by the health care organization within a given period.
Why is it important to insert a signature at the end of an email?
This allows the reader to know who they are speaking with and what role they hold in the healthcare system.
Who is known as the "Father of Medicine"?
Hippocrates, a Greek physician.
True or False
A CAP can act as an attorney.
False
What is another term associated with non-physician practitioners?
physician extenders