Claudia Anne Tanzer

Startup health insurer shutting

2010-06-05T12:36:00.000-07:00

Startup health insurer shutting

How Health-Care Reform Will Affect Small Business

2010-04-21T13:32:00.000-07:00

http://www.businessweek.com/print/smallbiz/content/apr2010/sb20100413_125807.htm

Samaritan Health System reduces unposted cash from $25 million to $4 million, improves A/R days

2010-04-21T13:28:00.000-07:00

http://www.caremedic.com/NewsView.aspx?id=51

GAMING THE HEALTH INSURANCE MANDATE

2010-04-21T13:25:00.000-07:00

GAMING THE HEALTH INSURANCE MANDATE

My networking letter

2010-04-21T12:20:00.000-07:00

Because of current market conditions and high unemployment, I am sure you have many
candidates for your Medical Billing Clerk position. Please allow me to give you a few reasons why you might want to call me ahead of other candidates who may have years of experience in medical billing and coding.

You will note that my background includes experience as a bookkeeping and
accounting professional.

I am able to work well and quickly with numbers and formulas and knowledge of
the laws, rules and regulations within which I must operate.

My recent completion of a comprehensive billing and coding course prepared me to
work well for any health provider.

I am hoping that your office would prefer a candidate with enough background,
experience and specific training to be open and flexible to how your facility
wants it done.

Recent changes with more expected in the healthcare industry which create
frustration for more experienced medical billing and coders, their employers and the consumers.

My character, personality and ability to apply my knowledge and experience make me
perfect for interacting with all involved in the billing process. I would greatly appreciate a few minutes of your time to discuss how my skills and knowledge can meet your business's needs.

Regards,

Claudia Tanzer
Enclosure: resume

Concierge Medicine: Convenient and Affordable Care - Brief Analysis #687

2010-01-31T08:57:00.000-08:00

Concierge Medicine: Convenient and Affordable Care - Brief Analysis #687

PROMETHEUS Payment: What's The Score

2010-01-30T19:31:00.000-08:00

PROMETHEUS Payment: What's The Score

All Roads Lead To Payment: Squeezing Value from Health Reform

2010-01-30T19:30:00.000-08:00

All Roads Lead To Payment: Squeezing Value from Health Reform

Building a Bridge from Fragmentation to Accountability - The Prometheus Payment Model

2010-01-30T19:28:00.000-08:00

Building a Bridge from Fragmentation to Accountability - The Prometheus Payment Model

What is PROMETHEUS Payment?

2010-01-30T16:56:00.000-08:00

What is PROMETHEUS Payment?

Comprehensive Medical Management helps docs tighten up finances

2009-12-28T10:12:00.000-08:00

http://cincinnati.bizjournals.com/cincinnati/stories/2009/12/28/story7.html?b=1261976400^2634911&ana=e_vert

Why audit health care claims

2009-12-25T13:46:00.001-08:00

http://www.healthcarehorizons.com/whyauditclaims.html

Medical Tourism: Health Care Free Trade - Brief Analysis #623

2009-12-14T09:33:00.000-08:00

Medical Tourism: Health Care Free Trade - Brief Analysis #623

Create Your Action Plan

2009-12-12T15:25:00.001-08:00

Create an action plan for first 3 months on the job

Put together a plan that covers what you'd do to maximize your first three months in

the new job. That means you have to put on your thinking cap:

What are the responsibilities of this position?

What goals/objectives were shared?

What do you need to learn in order to be effective?

Who do you need to meet with? For what reason?

What are the priorities? Strategic imperatives?

What needs to be put in place to ensure success?

What are the key issues and challenges?

●How can you minimize their impact?

Start by writing down all your thoughts about these questions. Then, start thinking

about sequence – what needs to be done first? Then what?

Finally, pull together a 2-3 page Action Plan as if the job were yours. Include the

following categories:

Overview of position/expectations
1st Week: Objectives & Plan
1st Month: Objectives & Plan
1st Quarter: Objectives & Plan

When you're done, review it carefully to ensure that it's exactly what you'd do – based

on your current level of understanding – should you be hired in the next few weeks.

Before you send it off, get someone to proofread it for you: Does it make sense?

Is it well written? Any typos or grammatical mistakes? If you want to

make the best possible impression, don'tomit this step!

Medical Insurance billing and bookkeeping resume NOV 2009

2009-12-12T10:59:00.001-08:00

Claudia Tanzer (901) 754-1799 claudiatanzer@gmail.com page 2

CLAUDIA A. TANZER

(901) 754-1799

claudiatanzer@gmail.com

LINKEDIN PROFILE: www.linkedin.com/in/claudiatanzer

WORK GOAL:

Expedient processing of health insurance claim forms to receive maximum allowable reimbursement for the health care practitioner. Achievable with my fifteen plus years as a bookkeeper and office administrative professional. Completed college coursework in medical insurance billing principles and practices through Techksills learning center of Memphis.

SUMMARY OF ACCOMPLISHMENTS:

Completed Robert Half/Accountemps assignments with high recommendation.

Implemented full cycle accounts payable system and trained employee to use software below time and budget.

Reorganized job duties and tasks to eliminate any overtime and save company money.

Found cost savings through auditing expense reports and vendor invoices.

Awarded Accountemps Employee of the Year in 2002.

Demonstrated ability to learn new material by completing Medical Insurance billing

Course work with “A” grade point average.

Save company money by taking on job responsibilities of two job positions.

SPECIAL SKILLS:

Proficiency in various packaged software applications including

spreadsheets, word processing, email, internet, Windows, accounting software.

Mathematical aptitude: work well with numbers and formulas.

Invoicing vendors, payment of invoices and applying payments.

Promptness, punctual, can do attitude, ready to assist co-workers.

RELATED WORK EXPERIENCE:

2007-2009 Contract Bookkeeping and spreadsheet preparation work, house and pet sitting, blog site development, volunteer work, personal income tax preparation, designed and sold artwork, inside door painting.

2001-2007 Accounts Payable Specialist, general accountant with Robert Half/Accountemps-Accounting staffing agency-continuous long term contract positions and short term projects in accounts payable, accounts receivable and billing, cash applications, financial research and spreadsheetpreparation, 1099 preparation, warehouse inventory update, financial data entry, FDA document control and accounting problem resolution

2005-2007 Income Tax preparer and customer service representative with H&R Block Tax Preparation Services.

2000-2001 Accounts Payable Specialist with Financial reporting duties, Lifeblood of Memphis- Regional Blood Bank other duties included handling office phones, back up for payroll person, handled confidential information.

1998-2000 Accounts Payable and purchasing specialist with Robert Half/Accountemps-Accounting staffing agency-continuous long term contract positions in purchasing, accounts payable and general accounting.

OTHER WORK EXPERIENCE:

1990-1998 Teacher training, student teacher, Sylvan tutor and Evaluator, substitute teacher with public and private schools, preschool and kindergarten teacher.

EDUCATION AND OTHER TRAINING:

Techskills of Memphis: January 2009-June 2009

4.00 grade point average in these courses;

Professional Development

Business Communication

Medical Law & Ethics

Microsoft Office Essentials 2003

Medical Administrative Essentials

Professional Billing Concepts

Medical Terminology

Advanced Medical Billing and Reimbursement

State Technical Institute of Memphis: 1998

QuickBooks for Windows

Intermediate Excel

Access Database Fundamentals

PowerPoint for Windows.

OVERALL 4.0 grade point average.

Associate of Science from State Technical Institute in:

Computer Accounting Technology

Graduated with High Honors .President’s List

Business Data Processing Technology.

Graduated with Honors, President’s List

Theta Kappa Honorary Society

Bachelor of Arts from Memphis State University in:

Political Science/Prelaw

Graduated with Honors

Elementary Education/Masters in Teaching program

Graduated with Highest Honors

PROFESSIONAL ORGANIZATIONS AND VOLUNTEER ACTIVITIES :

American Institute of Professional Bookkeepers

American Medical Billing Association

Health care Financial Management Association

Memphis Humane Society volunteer

Shelby Farms Regional Park volunteer

Hope House Art for Hope exhibit

Playhouse on the Square theatre usher

Theatre Memphis usher

Red Cross Disaster volunteer

Memphis schools volunteer tutor and student projects juror.

What is open Id and how can I obtain one.

2009-12-12T08:26:00.000-08:00

My web sites and social networking sites are using Open Ids to log into their sites.

What is OpenId, should you obtain one and how one obtains an open id can be answered
at this website:

http://openid.net/

I found this competitor to Google apps.

2009-12-09T16:55:00.000-08:00

If you are looking for online applications for word processing,spreadsheets, file sharing, database apps,online presentations, etc check out this site:

http://www.zoho.com/

Zoho is a very good alternative to google apps if you are apps onto desktop. This is
cloud computing.

Ibm office suite Symphony 1.3 download

2009-11-19T17:42:00.000-08:00

You can download a free office suite from IBM at:

http://symphony.lotus.com/software/lotus/symphony/home.nsf/home

Medical Billing Services - Outsourced Medical Billing Can Help Lower Expenses and Improve Collections

2009-11-18T16:41:00.000-08:00

Medical Billing Services - Outsourced Medical Billing Can Help Lower Expenses and Improve Collections

Health Finance Management Association has a resource library of useful articles for medical billing

2009-11-17T15:51:00.000-08:00

http://www.hfma.org/library/

I have a blog of my artwork and art exhibits

2009-11-17T14:22:00.000-08:00

You can see my artwork on this blogsite:
http://crossartbyclaudia.blogspot.com/

article that can be downloaded from hfma.org

2009-11-17T08:43:00.000-08:00

Patient Friendly Billing article from Health Financial Management Association.

http://www.hfma.org/library/revenue/PatientFriendlyBilling/High_Performance_Revenue_Cycle.htm

Digital Health Records: What to Expect

2009-10-26T17:01:00.000-07:00

If you’ve been following the news, you may have heard of President Obama’s plan to digitze all of the nation’s health records by the year 2014. In fact, the President has dedicated over $19 billion of his economic stimulus package specifically to kickstarting the digital health records revolution, by offering incentives to doctors and hospitals that take patients with Medicare and Medicaid (roughly 90% already do so), and setting up regional centers with “geek squads” to help physicians, hospitals and clinics get their digital records systems running smoothly. At the moment, only 17% of American doctors have a functioning digital records system in place, and less than 2% of the nation’s hospitals use electronic records in every department.

Obviously, this move will revolutionize the American health care system, effectively bringing it into the 21st century. But not everyone is happy about the change: Detractors have argued that the shift will do little to prevent costly medical errors such as misdiagnoses, and that the cost per office to make the switch to digital could be prohibitive, even with the government incentive. There are also worries about whether digital health records can adequately safeguard patient privacy.

What does all this mean for the medical billing profession? Fortunately, the shift to electronic records is great news for billers everywhere: Since almost all of their work is done on the computer already, it would be nice to see the rest of the industry catch up!

Are You HIPAA Compliant?

2009-10-26T16:59:00.000-07:00

Whenever you are working with sensitive medical information, you must always make sure that you are complying with the guidelines set forth by the Health Insurance Portability and Accountability Act (HIPAA). HIPAA was passed by Congress in 1996 to establish a national standard for the security of health data, in order to protect the privacy of the patient. If you work in the medical billing industry, it is absolutely vital that you comply with HIPAA and the US Department of Health and Human Services’ Privacy Rule. Failure to do so can have a number of serious consequences, including loss of accreditation, federal lawsuits, financial penalties, and even imprisonment for up to 10 years. Unfortunately, your billing career will likely be a complete loss as well. How can you avoid these violations? Always begin by making sure that any software you invest in is HIPAA compliant, complete with password protection and encryption technology, in order to safeguard patient data. If you need any additional guidance, try consulting the government’s official HIPAA website.

Medical Billing vs. Medical Coding: What’s the Difference?

2009-10-26T16:52:00.001-07:00

Medical billing and medical coding are two terms that are frequently mentioned in the same breath. To use the two interchangeably, however, would be a mistake. What’s the difference between medical billing and medical coding?

Essentially, medical billers build the bridge that connects physicians to patients and insurance providers. In order for a doctor or other medical specialist to receive payment for anything from a standard checkup to a costly operation, certain data regarding the nature of the services provided must be entered into billing software and transmitted to the insurance provider (or, if the patient lacks insurance, directly to the patient). Billers must have a keen eye for detail in order to ensure that all of the data provided is correct. They must also be prepared to follow up on delinquent accounts or investigate unpaid claims. Additionally, medical billers frequently work from home or in an office independent of the physician who employs them.

Medical coding, in contrast, focuses primarily on assigning the correct alphanumeric codes to the specific diagnoses and treatments outlined in each patient’s file. Coding requires a more in-depth knowledge of medicine, and is more likely to involve working with the medical provider on site. While it is entirely possible to forge a successful career in billing or coding alone, you may want to consider learning both in order to broaden your horizons and expand your employment opportunities.

Medical Billing Mistakes to Avoid

2009-10-26T16:50:00.000-07:00

Medical billing is an extremely detail-oriented profession. One single, seemingly tiny mistake can hold up an insurance claim and prevent the physician - your client - from receiving his or her payment in a timely manner. Such mistakes aren’t always easy to correct, either; the lengthy process of reviewing, fixing and resubmitting the claim can take valuable time away from your business. In the end, you even risk losing the trust of your clients.

Stop errors before they start by keeping the following commonly made medical billing mistakes in mind:

1. Wrong patient ID number. Always begin by double-checking the patient information!
2. Incorrect or missing physician ID. Likewise, make sure the physician is correctly identified.
3. Date of procedure not accurately reported. Again, this is an easy mistake to make - but it’s also easy to avoid.
4. Rates not accurately reported. Verify that the patient has been charged the correct amount for the services rendered.
5. Incorrect bill total. Always check your math!
6. Wrong codes provided. (A background in medical coding may prove extremely useful here.)

By and large, the majority of mistakes made by experienced, educated medical billers are easy to prevent with just a bit more attention to detail. Keep your focus on your work and your eye out for these common mistakes, and your billing practice will keep its sterling reputation.

This entry was posted on Friday, February 13th, 2009 at 1:38 am and is filed under

What is medical billing?

2009-10-26T16:46:00.001-07:00

Medical billing is one of the fastest-growing and most dynamic sectors of the health care industry. But what, exactly, does a career in medical billing entail? What is medical billing?

Essentially, medical billers serve as intermediaries between physicians or other health care providers and insurance companies, be they private or government-owned. Medical billing involves collecting fees from insurance companies in order to compensate doctors for their services.

A large number of health care providers rely on professional medical billers rather than handling their billing on their own. Why? Medical billers save physicians and their practices valuable time that they can instead devote to providing better care to their patients, and their expertise ensures that the billing procedure is carried out correctly. This makes the process easier on the insurance companies, and enables doctors to receive their payments in a more timely fashion. Additionally, professional medical billers save patients the trouble of dealing with doctors, insurance providers or even collections agencies. If you’re looking for a hands-on way to make a difference in the health care industry, medical billing may be the right career path for you.

Research health insurance options before deciding

2009-10-20T15:56:00.000-07:00

What you should know:

A health insurance policy is a contract between an insurance company and a person or a sponsoring group, such as an employer or government agency.
Most plans have a network of providers. Generally you pay less for care if you use an in-network provider. These providers agree to receive a lower payment for care to insured patients.
Health insurance policies are usually renewable annually. The premium is the amount the policy owner pays each month for health insurance. If you have individual insurance, you pay the entire premium-which might be very high if you have a chronic health condition. If you have group insurance you often pay only a portion of the premium.
Health insurance often requires costs beyond premiums. The deductible is an amount an insured person pays for care before the carrier begins paying. The copayment is a fixed amount you pay at each visit or procedure or for each prescription before the carrier pays. Coinsurance is the percent of all covered health expenses that an insured person must pay(often 20 percent) after the deductible has been met. The insurance plan covers the balance(often 80 percent).
Insurance companies have rules that may exclude payment for certain services. They also may require an authorization, referral or second opinion before allowing coverage of services. Rules might be waived temporarily for emergency care but may require notification of the carrier within 24 to 48 hours after the emergency.
Many employers offer group health insurance as part of their employee benefits packages. Employers usually have an open enrollment period each year, when employees can sign up for coverage, change coverage or add dependents to the plan.
Group insurance has several benefits. The sponsor, such as the employer or government, usually pays a large portion of the premium. Group policies often cost less per person because they spread out the risk among a lot of people, many of whom are will. In most cases, the insurance company agrees to insure everyone in the group, regardless of their condition or health history.
The average family health insurance premiums often costs more thatn $12,000 a year. The premium and out-of-pocket costs have increased greatly over the last eight years and are expected to grow.
Many people are denied health insurance or can't afford it. Many spouses and kids lose insurance coverage after a divorce. People often lose their health insurance when they lose their jobs. The cost of continuing a temporary policy(COBRA benefits) without the help of an employer can be exorbitant.
People without insurance often resort to extremely expensive emergency room care. Others do without needed care.
Many health insurance reform advocates want changes in the U.S. health insurance system including
(1) Ending discrimination against people with pre-existing conditions
(2)Preventing insurance carriers from dropping coverage on very sick people.
(3)Stabilizing and protecting Medicare and making needed prescription medication a covered benefits all year long.
(4)Preventing annual or lifetime limits on insurance coverage that cause many families to go bankrupt.
(5)Increasing access to preventive services to find health problems early when they are less costly and easier to treat.

What you should do

Choose your health plan and care providers wisely. Check their ratings, credentials, accreditations and reputation.
Before choosing a plan, find out if it will cover your needs and the costs. Make sure pre-existng conditions and the providers you need are covered.
Follow the rules of your plan. Know what your plan covers.
Be sure your providers get the required authorizations or referrals. Ask providers to make the required notifications to the carrier after an emergency.
Take charge of your health. Be involved in decisions about your care. Keep careful records of referrals, approvals, names of phone contacts and explanations of benefits.
Know your rights. In a true medical emergency, you have the right to be treated in a hospital, regardless of whether you have insurance.

source: Family Health...Take Charge provided by Memphis Common Table
healthymemphis.org

How much does an HSA cost?

2009-10-17T13:26:00.001-07:00

An HSA is not something you purchase; it’s a savings account into which you can deposit money on a tax-preferred basis. The only product you purchase with an HSA is a High Deductible Health Plan, an inexpensive plan that will cover you should your medical expenses exceed the funds you have in your HSA. However, HSA trustees often will charge fees for their services.

How can I get a Health Savings Account?

2009-10-17T13:25:00.001-07:00

Consumers can sign up for HSAs with banks, credit unions, insurance companies and other approved companies. Your employer may also set up a plan for employees as well.

What Is a “High Deductible Health Plan” (HDHP)?

2009-10-17T13:23:00.000-07:00

You must have an HDHP if you want to open an HSA. Sometimes referred to as a “catastrophic” health insurance plan, an HDHP is an inexpensive health insurance plan that generally doesn’t pay for the first several thousand dollars of health care expenses (i.e., your “deductible”) but will generally cover you after that. Of course, your HSA is available to help you pay for the expenses your plan does not cover.

For 2008, in order to qualify to open an HSA, your HDHP minimum deductible must be at least $1,100 (self-only coverage) or $2,200 (family coverage). The annual out-of-pocket (including deductibles and co-pays) for 2008 cannot exceed $5,600 (self-only coverage) or $11,200 (family coverage). HDHPs can have first dollar coverage (no deductible) for preventive care and apply higher out-of-pocket limits (and copays & coinsurance) for non-network services.

What is a Health Savings Account (HSA)

2009-10-17T13:22:00.000-07:00

Health Savings Account is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their health care. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.

You must be covered by a High Deductible Health Plan (HDHP) to be able to take advantage of HSAs. An HDHP generally costs less than what traditional health care coverage costs, so the money that you save on insurance can therefore be put into the Health Savings Account.

You own and you control the money in your HSA. Decisions on how to spend the money are made by you without relying on a third party or a health insurer. You will also decide what types of investments to make with the money in the account in order to make it grow.

^

DISASTER RECOVERY PLAN

2009-10-16T15:31:00.000-07:00

I posted steps to set up a disaster recovery plan can my bookkeeping blog:
at www.verythoroughbookkeeping.blogspot.com

Prometheus Payment

2009-10-13T15:11:00.000-07:00

Overview of PROMETHEUS Payment®:

PROMETHEUS Payment® (Provider payment Reform for Outcomes Margins Evidence Transparency Hassle-reduction Excellence Understandability and Sustainability) is a new provider payment model which offers a different approach to payment to include all providers treating a patient for specified conditions. The primary purpose of PROMETHEUS Payment® is to offer a sustainable payment model that will improve quality for patients, lower administrative burden for providers and plans, pay fairly, and provide useable, transparent information to propel improvement while facilitating choice where it can be exercised. PROMETHEUS Payment® begins with good clinical practice guidelines (CPGs) which should be brought to bear when treating a patient with a specific clinical condition. For more information on the PROMETHEUS Payment® program, please visit www.prometheuspayment.org.

2 white papers on Payment Reform by Health Care Financial Management Association.

2009-10-05T16:08:00.000-07:00

I found this 2 white papers very educational and helpful in understanding what
is happening in payment reform in today's health care reform climate.

Health Care Reform
A call to Action

Health Care Payment Reform: from Principles to Action.

I touched on each one of these responsibilities in my medical insurance billing coursework

2009-09-20T11:08:00.000-07:00

Responsibilities of the Reimbursement Specialist include the following:

1. Observe legal and ethical guidelines for safeguarding the confidentiality of patient and proprietary information.

2. Understands billing requirements for Medicare, Medicaid, contracted and commercial payers

3. Follows up on denials in a timely manner and proactively communicates any denial issues related to billing requirements

4. Reviews EOB for proper reimbursement

5. Monitors contracts and single patient agreements to ensure appropriate reimbursement is received

6. Ensures timely filling requirements are met and claims are followed up on in a timely and appropriate manner to eliminate timely filing denials and non-payment of claims

7. Understands governmental and commercial compliance regulations related to healthcare billing and accounts receivable management and where to locate the regulations

8. Reviews and researches insurance correspondence and makes necessary corrections to ensure claims payment

9. Follows up on unresolved account balances

10. Understanding of both UB04 claim for and CMS 1500 claim form

11. Provides insurance carriers with requests as necessary and timely

I am keeping up with the current debate over health care and insurance reform.

2009-09-20T10:06:00.001-07:00

The current efforts to overhaul our health care and medical system by Congress will have a direct impact on medical insurance billing specialists.

My reasons why you should interview me.

2009-09-14T08:07:00.000-07:00

Dear Employer,

Because of current market conditions and high unemployment, I am sure you have many
candidates for few medical billing and coding positions. Please allow me to give you a few reasons why you might want to call me ahead of other candidates who may have years of experience in medical billing and coding.

You will note that my background includes experience as an accountant and tax preparer.

I am able to work well and quickly with numbers and formulas and
knowledge of the laws, rules and regulations withing which I must operate.

My recent completion of a comprehensive billing and coding
course prepared me to work well for any health provider.

I am hoping that your office would prefer a candidate with
enough background, experience and specific training to be open
and flexible to how your facility wants it done.

Recent changes with more expected in the health care industry
which create frustration for more experienced medical billing
and coders, their employers and the consumers.

My character, personality and ability to apply my knowledge and experience make me
perfect for interacting with all involved in the billing process. I would greatly appreciate a few minutes of your time to discuss my options and glean any suggestions you can offer. I will phone you in a few days to see if we can schedule a brief meeting.
Thank you.

Regards,

Claudia Tanzer
Enclosure: resume

Some more imedical insurance terms

2009-09-01T09:39:00.001-07:00

AMBULATORY SURGERY-Surgery done in the doctor's office or at a surgical center, and not requiring an overnight stay.

CARVE-OUT POLICY-A contracted agreement between an insurance company and another company which provides special services to its members, such as prescription drugs or cancer treatment.

CLAIM-A record of medical services provided to a patient and submitted by the provider to the insurance company for payment.

CPT-4-A 5-digit code that applies to medical services.

FEE SCHEDULE-A listing of the maximum fee which a health plan will pay for services based on CPT billing codes.

ICD-9-A 3 to 5-digit number code describing a diagnosis or medical procedure.

INPATIENT-A patient who is admitted to a hospital and receives medical services from a physician during at least a 24-hour period.

OUTPATIENT-A patient who receives health care services, but not admitted to a hospital during a 24-hour period.

PRIMARY CARE PHYSICIAN-A physician, usually a general, family practitioner or internist, who delivers general health care, and is most often the first doctor a patient sees. This physician treats the patient directly, refers them to a specialist(or secondary care physician) or admits them to the hospital.

SUBSCRIBER-A person who enrolls in a health care plan and agrees to pay for premiums , co-payments and deductibles that are part of the plan.

TREATING PHYSICIAN-A physician who provides care to the patient while in the hospital,an usually works a the hospital or comes in as a specialist.

Some medical insurance terms.

2009-09-01T09:20:00.000-07:00

ANCILLARY PROVIDERS-Services over and above physician services, including laboratory,radiology, home health and skilled nursing facilities.

AUTHORIZATION-Approval of care required before a service is provided. Pre-authorization may be necessary before hospital admission, or before care is given by non-HMO providers.

BALANCE BILLING-Billing a patient for charges not paid by their insurance plan because the charges are above the usual and customary rate or because the insurer considered a procedure medically unnecessary.

CLAIMS REVIEW-The method by which a patient's health care service claims are reviewed before reimbursement is made. This is done to validate the appropriateness of services given and that the cost is not excessive.

COINSURANCE-A provision which limits the amount of the coverage paid by an insurance plan to a certain percentage, with the remaining costs paid by the member.

CO-PAYMENT-The portion of a claim that a member must pay out-of-pocket.

DEDUCTIBLE-The amount an insured member must pay before the insurance company pays benefit.

EOB(EXPLANATION OF BENEFITS)-A statement describing medical benefits and account activity, including explanation of why certain claims may or may not have been paid.

EXCLUSION-Services or supplies not covered under a health plan.

IN-NETWORK PROVIDER-Physicians and other service providers who are contracted with a managed care plan.

OUT-OF-NETWORK PROVIDER-Physicians who are not contracted with a managed care plan.

PROVIDER-A physician, hospital, laboratory, pharmacy or other organization that provides health care, goods or services.

PRE-CERTIFICATION-Also known as pre-admission certification, is the process of obtaining authorization from the health care plan for routine inpatient and outpatient admissions. Failure to obtain pre-certification may result in penalty to the provider or the subscriber.

REFERRAL AUTHORIZATION-Approval for a member to see a physician or access services outside of the participating medical group.

REFERRAL PHYSICIAN-A physician who sees a patient after another doctor has sent them for specialty care or services.

REFERRING PHYSICIAN-A physician who sends a patient to another doctor for specialty care or services.

Techksills Medical Billing program

2009-08-26T18:20:00.001-07:00

TechSkills' Medical Billing Skill set enables me to build skills to:

accurately document, store and retrieve a patient's medical data;

bill insurance companies the correct data to receive proper reimbursement on claims;

and follow proper medical office etiquette.

I am going to post information about medical insurance to help patients understand the process.

2009-08-26T13:57:00.000-07:00