Checkpoint: Eligibility, Payment, and Billing Procedures Essay

* Describe at least one factor that determines patient benefits eligibility ( p. 86-87 ) . If a patient has an HMO that may necessitate a primary attention supplier. the general or household pattern must verify a few things foremost. First the supplier has to be a program participant. back the patient must be listed on the plan’s maestro list. and 3rd the patient must be assigned to the PCP on the day of the month of service. The medical insurance specializer will so do certain that the patient is presently covered by their insurance.

If web information is required the specializer and the provider’s representative will interchange information online. If the remunerator wants to utilize the telephone the representative will be called. The patient’s benefits will besides be checked for what that insurance covers for them. There are some programs that do non cover all benefits. for illustration. pregnancy coverage and diagnostic X raies. may non ever be cover by a person’s insurance program.

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* What are the appropriate stairss to take when insurance does non cover a planned service? ( p. 87-88 ) When a patient’s insurance does non cover the services that they are seeking to have.

the patient is told they will be held responsible for the full charge. The patient must subscribe a fiscal understanding program before the supplier will travel on with the visit. Once the patient does subscribe this understanding. the patient will be seen and will be charged for any services from that visit. *

* Why do you believe it is so of import to do certain patients understand their payment duties before they receive services? * It is really of import that a patient understands that their coverage does non pay for the service that they are seeking to have. If the supplier merely went in front and seen the patient cognizing that their insurance did non cover them and so continue to bear down the patient the full sum on the measure. I think they could acquire into problem. The patient may be able to action the pattern for failure to explicate before the visit. If you do non state the patient and have them subscribe a signifier. so you should non acquire your money. *

* What are some possible effects to the patient or supplier if fiscal duties aren’t decently disclosed before services are given? * I believe that a patient may be able to action the pattern for failure to explicate before the visit. If you do non state the patient and have them subscribe a signifier. so you should non acquire your money. The patient is non responsible for the supplier or staff’s error. I think that a patient should cognize what their insurance screens before they proceed to travel and see their supplier. but it is still the provider’s duty to guarantee that they cover all the necessary stairss to acquire paid their money. *

Mention:
The McGraw-Hill Companies. 2008. Patient Encounters and Billing Information. Medical Insurance ch. 3. p. 86-88. Retrieved July 27. 2010 from University of Phoenix