Week 3 – DQ

Required Resources:

ISBN: 978-0-07-351371-3

Valerius, J., Bayes, N., Newby, C., Blowchowiak, A. (2012). Medical Insurance, an Integrated Claims Process Approach. (6th Ed.), New York, NY: McGraw-Hill Publishers.

• Chapter 7
• Chapter 8
• Chapter 9
• Chapter 10
• Chapter 11
• Chapter 12

ISBN: 978-0-7637-5964-3

Valerius, J., Bayes, N., Newby, C., Blowchowiak, A. (2012). Medical Insurance Workbook. New York, NY: McGraw-Hill Publishers.

Weblinks:

• CMS 1500 Form:
  http://highered.mcgraw-hill.com/sites/0073513717/student_view0/cms_1500_and_ub-04_forms.html#

Week 3 Discussion:

Lead-in:

An error in a form can delay payment to a healthcare provider, so it is important to submit a “clean” orerror-free claim to the appropriate payer. In your healthcare education you have learned about a variety of public and private payers like Medicare, CHAMPVA, and Blue-Cross/Blue Shield, among others. Each has its own requirements for information required for billing to be provided in a claims form.

To Prepare for the Assignment:

• Read Chapters 7, 8, 9, 10, 11 & 12 in Medical Insurance, an Integrated Claims Process Approach

With these thoughts in mind:

Post your primary response to DQ1 by Day 3: Choose two payers (e.g. Blue Cross/Blue Shield & Medicaid). Compare and contrast the requirements and differences in the fields required for these two payers. Finally, what 2-3 items would you double check to ensure you have a “clean claim” prior to submitting for the reimbursement?