Financial Procedures in a Health Care Organization

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Health insurance companies provide the majority of the payment for medical services that clinics and physicians deliver. After the care has been delivered, the medical record is reviewed for completeness, codes are applied, and the billing office submits the claim to the insurance company or other third party payer for payment. There are several steps to take when submitting a claim form to the insurance company for reimbursement. The result of a clean claim is proper reimbursement for the services the facility has provided.

Discuss the following:

  • What does it mean to submit a clean claim?
  • List all of the information that is important before the claim can be submitted.
  • Discuss some of the reasons why a claim may be rejected.
  • State various reasons for the importance of a clean claim submission.
  • Address the consequences of not submitting a clean claim.
  • What steps should be taken to check the claim status?
  • As the practice manager, how would you ensure that the claims process results in clean claim submission and very few claim rejections.

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