TAILIEUCHUNG - Lecture Medical assisting: Administrative and clinical competencies (2/e) - Chapter 15

Chapter 15 - Processing health care claims. This chapter also gives you the information you need about patients' financial responsibilities for services so that you can figure out how much patients should pay and how much will be billed to their health-care plans. | Medical Assisting Chapter 15 PowerPoint® to accompany Second Edition Ramutkowski • Booth • Pugh • Thompson • Whicker Chapter 15 Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Processing Health Care Claims Objectives 15-1 List the basic steps of the health insurance claim process. 15-2 Describe your role in insurance claims processing. 15-3 Explain how payers set fees. 15-4 Define Medicare and Medicaid. 15-5 Discuss TRICARE and CHAMPVA healthcare benefits programs. 15-6 Distinguish between HMOs and PPOs. Processing Healthcare Claims Objectives (cont.) 15-7 Explain how to manage a workers’ compensation case. 15-8 Apply rules related to coordination of benefits. 15-9 Describe the healthcare claim preparation process. 15-10 Complete a Centers for Medicare and Medicaid service (CMS-1500) claim form. 15-11 Identify three ways to transmit electronic claims. Basic Insurance Terminology Medical insurance (health insurance) is a written

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• Medical assisting
• Lecture Medical assisting
• Clinical competencies
• Administrative competencies
• Processing health care claims
• Liability insurance
• Clinical procedures
• Administrative medical assisting
• Clinical medical assisting
• Medical assisting profession
• Medical assistant credentials
• Administrative practices
• Clinical practices
• Medical assisting practice
• Responsibilities of the medical assistant
• Medical assisting organizations
• Medical assisting externships
• Externship scenarios
• Assisting in geriatrics
• Geriatric patients
• Medical office
• Accounting for the medical office
• Assisting in pediatrics
• Pediatric patient care
• Medical coding
• Diagnosis codes
• Minor surgery
• Medical asepsis
• Medical specialties
• Nursing careers
• Medical law
• Physician rights
• Externship process
• Expectations of externship candidates
• Insurance terminology
• Managed care plans
• Standard payment procedures
• Accepting payment
• Body organization
• Anatomical terminology
• Integumentary system
• Structure of skin
• Skeletal system
• Bone structure
• Skeletal muscles
• Muscular system
• Cardiovascular system
• Structures of the heart
• respiratory system
• Paranasal sinuses
• Nervous system
• Neuron structure
• Urinary system
• Renal sinus
• Reproductive system
• Male reproductive system
• Female reproductive system