AR person Role and Responsibility - Part 2

Charge Entry.

Here once again the AR person need not know exactly how charges are being entered, but he should have a working knowledge of how it is being done. For example should the carrier ask the AR rep what modifier was used? Then he should be able to figure out from the system (claim) where the modifier is so that he could effectively explain this to the insurance rep and have the claim processed for payment. Or should they need to know the place of service code or Type of service code then he should be able to check this on the claim and give a quick answer.

Place of Service.

This is a code given for treatments which for example when a patient is an inpatient i.e. admitted then it would be for Ex: Code 21, whereas for outpatient the code would be ex: 11. Therefore there are codes given for office visits, which area the service was performed in etc.

Type of Service.

Is a situation wherein what type of service is going to be performed, for example whether it is radiation treatment or anesthesia for each of these a code is given to specify the type of treatment.

Cash Posting

Once again the AR person need not fully understand how cash is being posted, but he would need to understand should a call be given to him to make which is paid by the Primary Insurance then it automatically means he would need to contact the secondary, otherwise he would not be able to calculate the allowed amounts, or know which insurance to call.The cash poster needs to review the Eob of the carrier the Eob is nothing else but a payment voucher where they would give details of the payment processed for a treatment under which Tax ID number and to which address the payment was sent. The cash poster needs to understand that he would have to take contractual adjustments based on the contract so that he does not make mistakes in posting. For example with Medicare under their rule they would pay only 80% which means in $ 100, they pay only 80 the remaining 20% needs to be collected from the patients secondary payer or from the patient itself.

Out of Pocket Expenses.

This is a situation where the patient after choosing for example Blue cross Blue Shield which is another carrier in the U.S.A. He would need to pay an amount during the beginning of each year so that his policy does not cancel out, therefore the carrier would deny any of our claims filed during that period when the patient is supposed to pay the amount, with a reason code that it is the "patients out of pocket expense". In this case the patient needs to be billed and the money collected.

Procedure Codes. (CPT)

An acronym for Current Procedural Terminology, CPT is a systematic method for coding procedures and services performed by physicians and other health care professionals.
Key points about CPT Codes.•CPT codes are five-digit numeric codes.•CPT codes describe procedures, services and supplies.•CPT codes represent the first level called level 1 of the HCPCS coding system.•CPT codes are self-definitive. With the exception of a few codes that contain the term "(specify)" in the description each code has only one meaning.•CPT codes are revised annually. Hundreds of CPT codes are added, changed or deleted each year. Because so many codes are added, changed or deleted, you need to purchase a new copy of CPT each year.

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