Explain denial codes and ways to correct errors

Reference no: EM132365527 , Length: word count:600

Assignment - Claims Denials and Appeals

Complete Parts A and B.

Part A: The Remittance Advice (RA) and Explanation of Benefits (EOB)

Resource: The following sections from Medical Insurance: A Revenue Cycle Process Approach (7th ed.):

Section 13.3 in Ch. 13
Figure 13.3: Sections of the RA

Review the following sections under the Payment Adjudication section in the CBCS Online Study Guide on the NHA dashboard.

Note: To access the NHA dashboard, use the NHA Access link provided in this week's folder.

Interpreting Remittance Advice

Common Notices
Components of an RA
Components of an RA Continued
RAs for Medicare Patients
Pop-Up: RAs vs. EOB

Write a 75- to 150-word response for each of the following questions. Use your own words and provide examples to support your answers.

1. What is the difference between an RA and an EOB?

2. Do you think the RA or the EOB is an effective method of communicating claim adjudication information to patients? Why or why not?

3. Do you think EOBs are easy or difficult to understand? Do you think patients are able to follow the information provided? Explain your answer.

4. What suggestions could you make to improve patient-payer communication regarding the claim adjudication process?

Part B: General Appeals Process

Resource: Section 13.6 in Ch. 13 of Medical Insurance: A Revenue Cycle Process Approach (7th ed.)

Review the following sections under the Payment Adjudication section in the CBCS Online Study Guide on the NHA dashboard.

Note: To access the NHA dashboard, use the NHA Access link provided in this week's folder.

Determining Reasons for Insurance Company Denial

Reasons for Claim Denial
Managing Denials
Group Codes
Claims Adjustments Reason Codes
Remittance Advice Remark Codes
Provider-Level Adjustments Codes
The Appeals Process
Internal Appeal
Pop-Up: Claim Denial

Write a 75- to 150-word response for each of the following questions. Use your own words and provide examples to support your answers.

1. Describe the purpose of the general appeals process, and identify the basic steps within the process.

2. Explain denial codes and ways to correct errors. Are there times the claims should be discussed with the provider?

Reference no: EM132365527

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