Scribd Logo
Upload

Welcome to Scribd!

  • 192 views

    1) What Is RCM?: HIPAA (Health Insurance Portability and Accountability Act of 1996) Is United

    Uploaded by

    Siraj P
    This document discusses various key concepts in medical billing and coding. It defines HIPAA as US legislation that provides privacy and security provisions for medical information. It describes Medicaid as covering low-income individuals regardless of age, while Medicare applies to those who have paid into the system and reached eligibility age. It also defines important terms like deductibles, coinsurance, copays, EOBs, allowed amounts, in-network vs. out-of-network providers, primary vs secondary payers, charge amounts vs expected rates, and the HIC number which has been replaced by the MBI.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    1) What Is RCM?: HIPAA (Health Insurance Portability and Accountability Act of 1996) Is United

    Uploaded by

    Siraj P
    192 views4 pages
    This document discusses various key concepts in medical billing and coding. It defines HIPAA as US legislation that provides privacy and security provisions for medical information. It describes Medicaid as covering low-income individuals regardless of age, while Medicare applies to those who have paid into the system and reached eligibility age. It also defines important terms like deductibles, coinsurance, copays, EOBs, allowed amounts, in-network vs. out-of-network providers, primary vs secondary payers, charge amounts vs expected rates, and the HIC number which has been replaced by the MBI.

    Original Description:

    Revenue cycle management

    Original Title

    What is RCM

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses various key concepts in medical billing and coding. It defines HIPAA as US legislation that provides privacy and security provisions for medical information. It describes Medicaid as covering low-income individuals regardless of age, while Medicare applies to those who have paid into the system and reached eligibility age. It also defines important terms like deductibles, coinsurance, copays, EOBs, allowed amounts, in-network vs. out-of-network providers, primary vs secondary payers, charge amounts vs expected rates, and the HIC number which has been replaced by the MBI.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    192 views4 pages

    1) What Is RCM?: HIPAA (Health Insurance Portability and Accountability Act of 1996) Is United

    Uploaded by

    Siraj P
    This document discusses various key concepts in medical billing and coding. It defines HIPAA as US legislation that provides privacy and security provisions for medical information. It describes Medicaid as covering low-income individuals regardless of age, while Medicare applies to those who have paid into the system and reached eligibility age. It also defines important terms like deductibles, coinsurance, copays, EOBs, allowed amounts, in-network vs. out-of-network providers, primary vs secondary payers, charge amounts vs expected rates, and the HIC number which has been replaced by the MBI.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 4

    1) What is RCM?

    2) What is medical billing?

    3) What is HIPAA?
    HIPAA (Health Insurance Portability and Accountability Act of 1996) is United
    States legislation that provides data privacy and security provisions for
    safeguarding medical information.
    The Health Insurance Portability and Accountability Act of 1996 was enacted
    by the 104th United States Congress and signed by President Bill Clinton in
    1996.
    4) What is medicare and medicaid?

    Medicaid is a federal program that is administered separately by each state.


    This is not the only difference between it and Medicare, however. Medicaid
    covers low-income people who don't have the financial means to afford
    healthcare on the private market, regardless of age, while Medicare applies to
    everyone who has paid into the system and reached the point of eligibility
    (age 65 or older).

    Medicare seeks to address the problem of the elderly having high medical
    bills, but increasingly limited means. Medicare recipients pay into Medicare
    through payroll or self-employment taxes.

    5) What is payment posting?Payment Posting In. ... Insurance Payment


    Posting: All payers either send an EOB (explanation of benefits) or ERA
    (electronic remittance advice) towards the paymentof a claim. The medical
    billing staff posts these payments immediately into the respective patient
    accounts, against that particular claim to reconcile them. EOB:An explanation
    of benefits (commonly referred to as an EOB form) is a statement sent by
    a health insurance company to covered individuals explaining
    what medicaltreatments and/or services were paid for on their behalf.
    The EOB is commonly attached to a check or statement of electronic
    payment.

    6) What is patient responsibilty?(copay,deductiable,coinsurance)

    This refers to the amount a patient owes a provider after an insurance


    company pays for their portion of the medical expenses. ... Place of Service
    Code: A two-digit code used on claims to explain what type of provider
    performed healthcare services on a patient.Copay:A copay is a fixed
    amount you pay for a health care service of $20, usually when you receive the
    service. The amount can vary by the type of service.
    Coinsurance:Coinsurance is a health care cost sharing between you and
    your insurance company. The cost sharing ranges from 80/20 to even 50/50.
    For example, if your coinsuranceis 80/20, that means that your insurer
    covers 80% of annual medical expenses and you pay the remaining 20%.
    Deductible:In an insurance policy, the deductible is the amount paid out of
    pocket by the policy holder before an insurance provider will pay any
    expenses. In general usage, the term deductible may be used to describe one
    of several types of clauses that are used by insurance companies as a
    threshold for policy payments.

    7) what types of claim forms?A claim form is a standard printed document


    used for submitting a claim. Under normal circumstances, reimbursement will
    take place within ten days of receipt and approval of claim form and all
    required documents. ... A claim form is a standard printed document used for
    submitting a claim.
    Types are:CMS1500=The CMS 1500 is the red ink on white paper
    standard claim formused by physicians and suppliers for claim billing.
    Although it was developed by The Centers for Medicare and Medicaid (CMS),
    it has become the standard form used by all insurance carriers.

    UB04=The UB-04 uniform billing form is the standard claim form that any


    institutional provider can use for the billing of medical and mental health
    claims. ... Although developed by the Centers for Medicare and Medicaid
    (CMS), the form has become the standard form used by all insurance
    carriers.

    8) what is HRA and HSA?Health reimbursement arrangements are notional


    arrangements; no funds are expensed until reimbursements are paid.
    Through HRAs, employers reimburse employees directly only after the
    employees incur approved medical expenses. This feature is especially
    helpful for businesses that want to retain control over their cash
    flow.HSA:A health savings account (HSA) is a tax-advantaged medical
    savings account available to taxpayers in the United States who are enrolled
    in a high-deductible health plan (HDHP). ... HSA funds may be used to pay for
    qualified medical expenses at any time without federal tax liability or penalty.

    9) what is refund amount? Refunds may need to be issued to a patient,


    responsible party, or to an insurance company (payer) in the event that an
    overpayment has been paid on a claim(s). Before issuing any refunds,
    the Refund report should be generated and worked in order to ensure that
    all refunds have been assigned appropriately.

    Overpayment: An Insurance overpayment is any payment that a


    provider receives in excess of the amount payable for a service rendered.

    10) What is cpt?Current Procedural Terminology (CPT) is a medical code set


    that is used to report medical, surgical, and diagnostic procedures and
    services to entities such as physicians, health insurance companies and
    accreditation organizations.

    11) What's an allowed amount? The maximum amount Priority Health will


    pay for each health care service covered by your plan. This may be called
    "eligible expense," "payment allowance" or "negotiated rate." If your provider
    charges more than theallowed amount, you may have to pay the difference.

    12) The difference between an inpatient and outpatient care is how long a


    patient must remain in the facility where they have the procedure
    done. Inpatient care requires overnight hospitalization. Patients must stay at
    the medical facility where their procedure was done (which is usually a
    hospital) for at least one night
    13) “In-network” health care providers have contracted with your insurance
    company to accept certain negotiated (i.e., discounted) rates. You’re correct
    that you will typically pay less with an in-network provider. “Out-of-network”
    providers have not agreed to the discounted rates.

    14) and other health insurance or coverage, each type of coverage is called a
    "payer." When there's more than one payer, " Coordination of benefits. " rules
    decide which one pays first. The "primary payer" pays what it owes on your
    bills first, and then sends the rest to the "secondary payer" to pay.
    15) The charge amount is the amount you are charging to the insurance
    company. Usually, because of contracted rates, the amount you charge an
    insurance company is not what you expect to be reimbursed for. ... The
    expected rate is the amount that you expect to receive as reimbursement.
    16) Medicare beneficiaries used to receive a plastic Medicare card with a
    Health Insurance Claims, HIC, number. The HIC number identifies the
    Medicare beneficiary in the Medicare system, allowing for the smooth
    processing of claims and ensuring benefits are routed to the correct places. A
    HIC is sometimes called a HICAN or HICBIC. It has recently been replaced
    with a randomly generated Medicare Beneficiary Identifier, or MBI, which
    serves the same purpose.

    You might also like