The life cycle of a medical claim can be very confusing for new staff. Each staff member plays a different part in contributing to the claim and pertinent documentation or submission of the claim. Nurses and clinical staff may not have as much to do with filling out claims forms as billers do, but they need to know what types of insurances require additional documentation and forms; front desk staff will need to know when to collect coinsurance and balance bills and when to ask for secondary insurances; coders will need to know any special coding requirements for secondary insurances. Billers will need to understand the entire cycle.
In this scenario, you are playing the role of a trainer and you will create an essay explaining the left cycle of a claim to new employees.
The essay should explain the Life Cycle of a Claim in health care. It should include the points below.
Patient Pre-Registration
Establish Financial Responsibility
Patient Check-in & Check-out
Superbill (Encounter Form)
Prepare and Transmit the Claim
Monitor Payer Adjudication
Generate Patient Statement
Follow up Payments and Collections
