Medical_Terminology

Jimmy Nazario Fifth Week Application Assignment Prof. Paula White MBC 105: Insurance, Billing and Coding I 05 Application Assignment 1. Admitting Clerk – registers the patient by interviewing and obtaining personal (demographic and insurance information and admitting diagnosis or symptoms. 2. Insurance Verifier – may work either at the hospital or from home, reads the photocopied insurance identification card and may telephone the patient or physician for additional data. During or after admission, the insurance verifier’s primary responsibility is to either swipe the card through scan equipment or contact the insurance plan by either a computer or telephone to verify eligibility, predetermine coverage, and obtain authorization if necessary. 3. Attending Physician, Nursing Staff, and Medical Transcriptionist – It is the attending physician’s responsibility to dictate a history and physical (H&P) on admission that lists the admitting diagnosis. A medical transcriptionist transcribes the dictation into a report form. The nursing staff and the attending physician enter daily notations on the patient’s medical record as the patient receives medical services. 4. Health Information Management (HIM) – The HIM is composed of the following: - Medical Records Clerk – assigns a medical record number at the time of admission. The medical record number never changes (even on future admits), and all records are complied under this number. - Discharge Analyst – checks the completeness of each patient’s medical record for dictated reports and signatures. He or she completes a deficiency sheet that is put on the medical record indicating any documentation deficiencies. - Code Specialist – Abstracts procedures and diagnoses from the patient’s health record and assigns the appropriate codes for the services given. 5. Nurse Auditor or Utilization Review (UR) Nurse – Registered nurse that verify the doctor’s orders and the medical record against each charge item on the bill. The nurse must have clinical and financial expertise. 6. Insurance Billing Editor – Reviews the generated electronic claim before it is generated as a paper claim or transmitted electronically to the appropriate insurance company to obtain payment. Information from the patient’s financial data may be compared to verify insurance information. 7. Payments and Collection Department – After receipt of payment from insurance and managed care plans, the patient is sent a net bill that lists any owed deductible, coinsurance amount, and charges for services not covered under the insurance policy. Collection of electronic claims starts 14 days after submission while collection of hard copy claims should begin after 30 days after submission.