In this Medical Billing Training course, you will learn the following points and much more: Parties Involved in Billing

• Parties Involved in Medical Billing

• Types of Providers

• Types of Patients

• Federal & Commercial Carriers

• Primary, Secondary, Tertiary Insurance

• Copay, Co-Insurance, Deductible & OOP

• In -Network & OON

• Types of Health Insurance plans (HMO, PPO, HDHP..)

• MVA, WC , Self Pay

• Medical Billing Cycle

• Patient Scheduling , No Show

• Insurance Verification

• Patient Demography

• Fee Schedule, Place of Service

• Charge Posting, Cross over

• EDI Enrollment

• Clearing House, Claim Submission, Electronic & Paper

• Billed, Allowed, Paid & Write off

• ERA, EOB & Payment Posting, FFS, Capitation, With hold, Offset, Refund

• Interest Payment, Late Charges, Medical Record Payment & NSF

• Denial Scenarios

• AR Analysis

• AR Follow-up

• Credit Balance Review

• Patient Statements & Collections

• Bad Debt

• Bankruptcy

• AR Days, Net Collection & Denial Rate

• Reporting

Denial Analysis:

1)Patient & Demographic Based Denials:

• Coverage / ID Problem

• Waiting for Additional Info from Patient

• Insurance Address Change

• Patient Not in System

• Pre-Existing Condition

  
  

2)Coding based Denials:

• Procedure (CPT)/Diagnosis Problem

• Included w/ Primary or Other Procedure

• Included in Global Rules

• Down Coding Explanation

• Modifier Required

  
  

3)Payment Based Denials:

• Inappropriate Payment Amount

• Maximum Benefits Paid by Primary Ins

• Refund Request

• Overpayments

• Withhold Amount

  
  

4)Provider Based Denials:

• W9 Request

• Physician / Group Info Needed

• Need Physician Signature

• Medical Records Needed

• Not Medically Necessary

  
  

5)Other Denial Categories:

• Insurance Needs Additional Info / Re Submit Claim

• Need Copy of EOB

• Need to Contact Ins Co. for further Info

• Bankruptcy Letter Received

• Attorney Requesting Information

Insurance Follow Up Scenarios:

• Claim not on file

• Claim in process

• Claim Paid

• Denied as Duplicate

• Claim Pended

• Additional info required from Provider

• Additional info required from Patient

• Claim denied for PCP Referal

• Denied for authorization

• Denied as Dx Code Inconsistent

• Untimely Filing Denial

• Provider not available with Insurance record

• Third Party Pricing

• OON

• Claim paid to incorrect address

• Claim Offset