CS205 Wk 5 Heather Johnson
1. Explain the purpose of having sequential reference numbers on a superbill (encounter form).
A: Having a sequential reference number on a superbill allows for easy identification and matching the document to the services that were posted. It can make correcting a billing or book-keeping error much easier.
2. Besides the physician's office, describe some locations where patients receive medical services from the doctor.
A: Hospital (in-patient or out-patient) Emergency room, Nursing home, Urgent Care facility, Hospice, Home health (in-home visits) Specialty clinics (i.e. dialysis, cancer treatment, etc.()
3. A physician has treated a patient who has a diagnosis that is not listed on the superbill. How is this handled by the physician? The medical biller?
A: The doctor can write it in the “Diagnoses not listed” section of the superbill. The medical biller will then code that written diagnoses if necessary.
4. Explain the purpose of the Advance Beneficiary Notice (ABN).
A: An ABN advises Medicare beneficiaries that certain procedures may not be covered by Medicare or that Medicare will deny claims for these services. This allows the patient to take a more active role in the healthcare they receive. They have a role in deciding if a procedure is really necessary for them. They can still choose to receive the services or procedure, but they will know up front that they have to pay for it out-of-pocket.
5. Explain the importance of having authorization from a health plan when providing and billing for services.
A: If a healthcare plan requires prior authorization for services it means the office staff needs to contact the insurance company and explain what services are going to be provided to the patient. The insurance company will the either authorize or deny services. If they are authorized, the medical office will receive an authorization number and/or authorized dates of service. If a prior authorization is needed and NOT received, billed services for that
A: Having a sequential reference number on a superbill allows for easy identification and matching the document to the services that were posted. It can make correcting a billing or book-keeping error much easier.
2. Besides the physician's office, describe some locations where patients receive medical services from the doctor.
A: Hospital (in-patient or out-patient) Emergency room, Nursing home, Urgent Care facility, Hospice, Home health (in-home visits) Specialty clinics (i.e. dialysis, cancer treatment, etc.()
3. A physician has treated a patient who has a diagnosis that is not listed on the superbill. How is this handled by the physician? The medical biller?
A: The doctor can write it in the “Diagnoses not listed” section of the superbill. The medical biller will then code that written diagnoses if necessary.
4. Explain the purpose of the Advance Beneficiary Notice (ABN).
A: An ABN advises Medicare beneficiaries that certain procedures may not be covered by Medicare or that Medicare will deny claims for these services. This allows the patient to take a more active role in the healthcare they receive. They have a role in deciding if a procedure is really necessary for them. They can still choose to receive the services or procedure, but they will know up front that they have to pay for it out-of-pocket.
5. Explain the importance of having authorization from a health plan when providing and billing for services.
A: If a healthcare plan requires prior authorization for services it means the office staff needs to contact the insurance company and explain what services are going to be provided to the patient. The insurance company will the either authorize or deny services. If they are authorized, the medical office will receive an authorization number and/or authorized dates of service. If a prior authorization is needed and NOT received, billed services for that