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CYCLE OF HEALTH INSURANCE

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CYCLE OF HEALTH INSURANCE
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FROM PATIENT TO PAYMENT:
UNDERSTANDING MEDICAL
INSURANCE
KEY TERMS

Step 1

S te
St

ep

10
Follow up payments and collections

Preregister patients p2

Establish financial responsibility
St

ep

3

S te p

9

Generate patient statements

Check in patients Monitor payer adjudication

Review coding compliance St

ep

8

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Check out patients Review billing compliance p7

St

ep

5

S tep 6

Learning Outcomes
After studying this chapter, you should be able to:

1.1 Explain how healthy practice finances depend on correctly accomplishing administrative tasks in the medical office.

1.2 Compare coinsurance and copayment requirements for health
Copyright © 2014 The McGraw-Hill Companies

plan benefits.

1.3 Identify the key steps in the medical billing cycle.
1.4 Discuss the impact of electronic health records on clinical and billing workflow.

1.5 Evaluate the importance of professional certification and of medical liability insurance for career advancement.

S te

p4

Medical Billing Cycle

Prepare and transmit claims

1

accounts payable (AP) accounts receivable (AR) benefits cash flow certification coding coinsurance copayment covered services deductible diagnosis documentation electronic claim (e-claim) electronic health record (EHR) fee-for-service health care claim health information technology (HIT) health plan indemnity plan managed care managed care organization (MCO) medical assistant medical billing cycle medical documentation and billing cycle medical insurance medically necessary noncovered (excluded) services out-of-pocket PM/EHR policyholder practice management program (PMP) preauthorization premium procedures provider remittance advice (RA) revenue cycle management (RCM) statement third-party payer

1

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