HCM 1201 South University Online Wk 5 Format and Structure Discussion

Instructions

Introduction:

In order to properly code a bill for medical necessity, it is important to understand different plans and the requirements for billing each. It is true that they all use the ICD-10-CM diagnosis coding system, the CPT procedure coding system, and the CMS-1500 form, but each type of carrier has certain requirements for a clean bill.

Tasks:

  • Create a billing manual constructed of summaries of each type of insurance.
  • Include the major requirements for billing for each type.
  • Note inpatient or outpatient differences where appropriate.
  • Explain how to determine from the patient which type they subscribe to.

Submission Details:

  • Submit this topic as an 8- to 10-page Microsoft Word document. Use APA standards for citations and references.
  • Cite a minimum of three outside peer-reviewed sources to support your assertions and save it as SU_HCM1201_W5_Project_LastName_FirstInitial.doc. Submit the report to the Submissions Area by the due date assigned.
  • Cite any sources using correct APA format on a separate page.

Expert Solution Preview

Q: What is the purpose of understanding different insurance plans and their requirements for billing medical services?
A: In order to properly code a bill for medical necessity, it is important to understand different plans and the requirements for billing each. While they all use the same coding system and billing form, each type of carrier has certain requirements for a clean bill. By understanding these requirements, healthcare providers can avoid claim denials, delayed payments, and potential legal issues.

Q: What should be included in a billing manual constructed of summaries of each type of insurance?
A: A billing manual constructed of summaries of each type of insurance should include the major requirements for billing for each type. This includes the necessary codes and forms, specific billing procedures, documentation requirements, and any other relevant details that need to be addressed. Additionally, any inpatient or outpatient differences should be noted where appropriate. The manual should be clear and concise, providing healthcare providers with the necessary information to successfully bill each type of insurance.

Q: How can healthcare providers determine from the patient which insurance plan they subscribe to?
A: Healthcare providers can determine from the patient which insurance plan they subscribe to by asking the patient for their insurance card or by having them provide their insurance information. Additionally, many electronic medical record systems can check insurance eligibility in real-time, helping to ensure that claims are accurately coded and submitted. It is important for healthcare providers to be aware of the specific requirements for each insurance plan in order to avoid errors in billing.

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