Apex Family Medical Center will bill patients and/or their insurance carriers instead of accepting payment at time of service. Determination of professional charges may not be complete until several days after services are rendered.
Determining Professional Charges to Bill
Completed attending physician notes will be in the patient medical record within seven working days of the patient encounter.
Center staff may only submit professional charges for patient procedures on the basis of notes in the medical record. Notes must be authored by the provider who performs the procedure. Notes must also conform to current documentation requirements.
Center staff may submit professional charges for clinic encounters before a complete written attending physician note is in the record as long as the record indicates that:
the billable patient encounter occurred.
a clinical diagnosis and treatment plan have been provided.
the level of patient encounter is consistent with the clinical diagnosis and plan.
Patient Billing Basics
Patient accounts are billed monthly. Insurance accounts are billed weekly.
Each individual claim must be reviewed for accuracy. Claims are submitted or mailed the day of billing.
Billing department specialists serve as resources for questions about insurance coverage and/or billing. A specialist will be assigned to the front desk during all office hours. Patient in-person and phone inquires should be referred to the assigned specialist.
Unpaid claims of 60 days or older must be reviewed by a billing department specialist, who will follow up with third-party payers.
Any written or verbal communication from outside agencies must be shared with the billing department manager.
Billing staff nonroutine activities, exceptions, and notable events should be shared with the billing department manager.
Medicare, Medicaid, and other newsletters and bulletins are posted in the Billing Office. The billing staff should also subscribe to relevant insurance electronic news services.
All staff will comply with HIPAA Policies and Procedures.
Question
You work at the front desk of Apex Family Medical Center. The primary purpose of this document is to:
A.explain why the clinic sends patient bills instead of expecting payment at time of service.
B.inform patients of billing policies and procedures.
C.update staff about obtaining current insurance coverage information.
D.outline steps for determining charges and processing patient records.
E.provide general guidelines for determining charges and billing patients.
1 answer
The primary purpose of this document is to:
B. inform patients of billing policies and procedures.
While the document does touch on various aspects such as determining charges and how to handle documentation, the overall focus is on the billing policies and procedures that patients and staff need to be aware of.
