What does a medical administrative assistant do when a claim is rejected?

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How do you respond to a rejected claim?
What is submitted when a provider feels a claim was incorrectly denied?
When a claim is denied by the insurance carrier what is the next step?
What does it mean when a claim gets denied?

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Term	Definition
A provider office receives a remittance advice showing a denial code. The CMA creates formal written request for review of the rejected claim. The CMA should do which of the following	Appeal the claim
Which of the following types of files should a medical administrative assistant maintain in order to remind patients of future appointments or procedures?	Tickler
Which of the following forms is required to ensure a clean claim is submitted for an established patient	Encounter form
Which of the following actions should a medical administrative assistant take when collecting money owed by a patient?	Clarify the patient's financial responsibility policy
CMA is asked to create labels for the practice's patients. Which of the following wordprocessing software features should the assistant use	Mail merge
When leaving a message for a patient regarding an upcoming appointment which of the following information should the CMA include in the message	The name of the practice
Which of the following actions is appropriate for the CMA to take when processing incoming mail	Shred unwanted mail
A collected specimen needs to be sent to an outside lab. Which of the following actions is within the scope of practice of a CMA	Process the requisition for shipment
What should the CMA use to determine the proper way to dispose of an expired chemical cleaning product	MSDS (Material Safety Data Sheet)
Insurance policies contain which of the following revisions to avoid overlapping payments	Coordination of benefits
Which of the following should a CMA do to explain to new a patient prior to an initial visit	The procedure for canceling appointments
Which of the following describes a provider who has a contract with a third-party payer	PAR (Participating Providers)
Which of the following describes an urgent referral	When it takes 24 hours to receive approval and is for a non-life-threatening condition
A physician is called out of the office for an emergency while the patients are in the waiting room. After informing the patients, which of the following is the most appropriate way for the medical administrative assistant to manage the patients?	Try to reschedule patients before they leave
Which of the following information is necessary to confirm a patient's demographics?	Occupation
A medical administrative assistant should include which of the following in the compliance plan when training a new CMA	HIPPA compliance
Implied Consent	obligations that are understood without verbally expressed terms (Unconscious Patient)
Informed Consent	A written form that states the understanding of the prescribed treatment
Physician-Patient Relationship	The physician is expected to assess and treat the patient with the same amount of knowledge, skill, and judgement as another Physician would
Good Samiritan Act	A volunteer who is not responsible for any harm or injury caused while trying to help someone in an emergency
Abandonment	The dicontinuation of a medical care without proper notice
Arbitration	The usage of an impartial third party for the hearing and determination of a dispute
Battery	The unlawful use of force or violence
Negligence	The failure to provide the necessary care that is required for a persons situation
Statues	Laws enacted by the legislative branch of a government
Non Verbal Communication	Eye Contact- Facial Expression- Body Language
Matrix	The time marked in the appointment book when the physician is not available
Wave Scheduling	A certain # of patients are scheduled to arrive at the same time and are seen in which the order they arrive
Modified Wave Scheduling	Small groups of patients are scheduled at intervals throughout the hour
Double Booking	Scheduling two patients to see the physician at the same time
Modified Block Letter Style	The signature and Salutation is centered
Express Mail	available everyday of the year including holidays (Items up to 70lbs in weight and 108 inches in height)
First-Class Mail	Letters- Postal Cards- Postcards- Business reply mail
Priority Mail	First-Class mail that weighs more than 13 ounces
Certified Mail	Gives the sender the option to recieve proof of delivery
Bulk Mailing	Mailing large volumes of information which is presorted by zip code
Individual Policies	For those ineligible to recieve benefits from a government plan((High Premiums&Limited Benefits))
Group Policies	Provides Insurance for employees under a single contract((Greater Benefits&Low Premiums))
Government Plans	Available to a large group of people who meet specific eligibilty criteria((Medicaid- TRICARE- Medicare- Workers Compensation))
Assignment of Benefits	A patient requests that their health benefit payments be made directly to a physician
Benefit	The amount payable by the carrier toward the cost of services
Deductible	Amount the patient pays for health care expenses before insurance
Co-Payment	The portion of a service fee that a patient must pay
Policy	Document that describes the insurance coverage for an individual
Premium	The amount the patient pays for an insurance contract
Covered Expenses	Amount customarily charged for similar services and supplies which are medically necessary
Waiting Period	A period of time when you are not covered by insurance for a particular problem
((Medical Records))Patients Cheif Complaint	A statement of the patients symptoms
SOAP((S))	Subjective impressions
SOAP((O))	Objective clinical evidence

How do you respond to a rejected claim?

Simply state that you are appealing the decision. Explain why you disagree with the decision. Provide support for your claim..

Request a copy of your insurance policy. ... .

Stay in treatment, and follow the recommendations of your treatment team..

What is submitted when a provider feels a claim was incorrectly denied?

A "Reconsideration" is defined as a request for review of a claim that a provider feels was incorrectly paid or denied because of processing errors.

When a claim is denied by the insurance carrier what is the next step?

If your insurance company refuses to pay the claim, you have a right to file an appeal. The law allows you to have an appeal with your insurer as well as an external review from an independent third party. You must follow your plan's appeal process. Check your plan's web site or call customer service.

What does it mean when a claim gets denied?

A claim rejection occurs before the claim is processed and most often results from incorrect data. Conversely, a claim denial applies to a claim that has been processed and found to be unpayable. This may be due to terms of the patient-payer contract or for other reasons that emerge during processing.

What does a medical administrative assistant do when a claim is rejected?

How do you respond to a rejected claim?

What is submitted when a provider feels a claim was incorrectly denied?

When a claim is denied by the insurance carrier what is the next step?

What does it mean when a claim gets denied?

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