Forms Related to Medical Billing
There are various forms related to medical billing. Many forms are related to the patient and the treatment and care of the patient. Other forms are related to the financial operation of the practice. These forms include the claim form, explanation of benefits, statements and payment collection.
Whether you are the patient, the front desk personnel, or the billing desk personnel in the medical billing office, the accuracy of the forms are vital to getting a health claim paid for a patient.
1. The completeness of the documentation provided by the patient is essential to the medical billing office.
2. The legible photocopies of health insurance cards and identification is the responsibility of the receptionist or front desk personnel. This person also collects co-payment and out-of-pocket amounts from the patient or guarantor.
3. The comprehensiveness of the billing forms that ultimately generate claims are the responsibility of the insurance billing specialist.
Forms Handled at the Front Desk
The forms handled at the front desk are related primarily to registering the patient and include the following types of forms:
1. Health Insurance CardsThe forms handled at the front desk are related primarily to registering the patient and include the following types of forms:2. Patient Registration Forms
3. HIPAA Forms
4. Release Authorization Forms
5. Insurance Verification Forms
6. Advanced Beneficiary Forms
1. Health Insurance Cards
The example image on the right are some of the health insurance cards that can be encountered in the medical office.
2. Patient Registration form
so that the provider has the most current patient demographic information.
Registration form also helps the medical billing personnel to identify who is responsible for paying the bill if there is a balance due by the secondary, tertiary insurance (if any) and patient responsibility as well.
3. HIPAA Forms
Without permission medical office cannot disclose patient's health information to anyone for any reason.
Any person or organization that electronically trasmits or stores individually identifiable health information is considered a covered entity and is required by law to comply with HIPAA.
4. Release Authorization form - http://img.docstoccdn.com/thumb/orig/124823538.png
In most cases, Protected Health Information (PHI) can only be released with written consent or authorization from the patient or guardian.
5. Insurance Verification form
Some medical billing office verify the patient's insurance eligibility prior to patient's office visits.
Insurance verification is typical in a large medical office, such as surgery center that has many patients and that performs various types of procedures.
It is important to know that any benefits that are quoted for patient eligibility does not guarantee payment from insurance payer.
6. Advanced Beneficiary Notice form
When an ABN for is drafted and given to the patient properly financial liability shift from the medical billing office to the patient in situations where Medicare does not cover services for lack of medical necessity. The form notify the patient in advance of receiving the service of the likelihood of non-coverage.
If ABN form is not signed before the procedure/service is provided and Medicare denies the coverage, the perception is that provider is providing free services to Medicare patients - this is considered fraud by the Office of the Inspector General for CMS!
Forms Handled at Billing Desk
The forms handled at billing desk are primarily related to the financial operation of the practice and include the following types of forms:
1. Encounter Forms
2. Medical Records
3. CMS-1500 & UB-04 Claim Forms
4. Explanation of Benefits
5. Patient Ledger Card
5. Patient Ledger Card
6. Patient Itemized Statements
7. Payment Agreement Letter
8. Collection Letters
1. Encounter form
The encounter form includes the date of service, the procedure and the reason or symptom that led to office visit. The form also include diagnosis, procedures, and descriptions and follow up strategies, if applicable.
The provider records the information regarding the patient's care on the encounter form and then forwards it to the medical billing specialist.
2. Medical Record
The Medical Record includes various documents, for example, New Patient Form, Medical History, Lab reports, Physician Notes, and others.
Medical coders use the documents in the medical record to code the Superbill or Charge Ticket.
3. CMS-1500 Claim form
This form is submitted to payers for reimbursement of medical services.
The CMS-1500 claim form is used to bill the professional services of healthcare providers.
Chargers for the Hospital or surgery center submit
The form can also be submitted electronically in Electronic Medical Claim (EMC).
4. Explanation of Benefits (EOB)
The EOB is not a bill, but it does include the following information:
a. Date of Service
b. Provider Name
c. Amount Billed
d. Amount allowed by payer
e. Payment amount
f. Balanced owed by patient, including deductible and copay information.
This form might also include denials and reason codes if any portion of the claim is not paid.
5. Patient Ledger Card
It is a record of all financial transactions between the patient and provider. These are chargers of personal or carrier payments, all are posted on patient financial accounting record.
If the practice is using computer here is the one of the example of computerized patient accounting ledger.. Courtesy image from Medlook a practice management software.
6. Patient Itemized Statements
Statement specify a description of the services rendered, the billed amount, and any payment or adjustment that has been applieed to the charge and the remaining balance.
The statement always includes where to remit payments.
6. Payment Agreement Letter
Often a patient account representative will offer payment plan options to patient who have an outstanding balance on their account.
Sometimes it is helpful to set up a payment agreement with patients who have a history of delinquency and are concerned about their account being reported to credit agency.
7. Collection Letter
This form is a collection letter that is sent to guarantor or patient who have not responded to monthly billing statements.
The outstanding balance on the account is due by the patient. A collection letter is used to remind the patient of the possibility of having the account sent to a collection agency.
I am aware that each office use different types of Practice Management Software. I just want to share what I have found on the internet and
