FREE Medical Billing General Question and Answers
The sum an insurance provider is charged for services:
Explanation:
All insurance providers must be assessed the same usual and customary amount (U&C). To ensure full reimbursement, the U&C sum should always be set higher than the highest-paying insurance provider.
A test costs $400 and is provided. The patient is responsible for $23.56 while the insurance company pays $300. What are the terms for the contractual discount and the patient's obligation?
Explanation:
Copays are a flat fee, whereas coinsurance is a percentage of the contractual allotment. The contractual discount is the usual and customary amount (U&C) less reimbursement and less patient obligation. The contractual allowance is the sum for which the provider was directly reimbursed plus the patient's duty.
What is the acronym of Early and Periodic Screenings-Diagnosis-and Treatment?
Explanation:
Children under the age of 21 who are registered in Medicaid can receive comprehensive and preventative health care services through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. In order to guarantee that kids and teenagers receive the proper preventative, dental, mental health, developmental, and specialist care, EPSDT is essential.
When a patient calls, they request a copy of their most recent visit's chart. How soon must you provide them with their records?
Explanation:
HIPAA is allowed 30 days under the Privacy Rule, and an extra 30 days may be added if you notify the patient in writing.
Maggie visits the chiropractor once every week and has Medicaid. Maggie is told by the chiropractor that she must pay a $25 copay for each visit even though she has Medicaid. There is no copay on Marge's insurance card. When Maggie questions the billing office, they inform her that her insurance only pays $17 for each chiropractic visit and that it would be cheaper for her to pay the $25 out-of-pocket. In accordance with Medicaid rules:
Explanation:
Medicaid patients cannot be billed without their written consent. The chiropractor needs to give her her money back and correctly charge her insurance. The remaining sum cannot be charged to the patient later, even if a service is not covered when invoiced to Medicaid.
What distinctions exist between inpatient and pro-fee coding in terms of how they are paid for?
Explanation:
Each CPT code has a pricing structure for the reimbursement of professional fee visits. ICD-10 CM diagnosis codes are not reimbursable in a professional context, however, inpatient facility reimbursement is based on Diagnosis Related Groups (DRGs), which are groups of related diagnoses. Although they are employed in an inpatient context, ICD-10 PCS procedure codes are not reimbursed.
The time frame for filing a claim with Medicare is:
Explanation:
Medicare claims must be filed within 365 days or one year. Other insurances, including Humana, have 90-day timely filing deadlines. After a year, claims can still be submitted to Medicare, but they will be rejected for not being timely filed, and no payment will be made.