What area(s) of the life cycle of the claim is affected by your position? Explain how you will ensure that you are providing error-free information. What area(s) of the life cycle of the claim do you find challenging? Explain how you can learn more about these areas?

The Life Cycle of an Insurance Claim

 

The life cycle of an insurance claim includes many healthcare billing disciplines (Shoukat, 2021). A medical office administrator is mainly concerned with collecting and submitting data to insurance providers and subsequent appointment scheduling. These roles occur mainly in the realms of claim submission, reimbursements and collections, and patient service. To ensure that I am providing error-free information, I will verify medical coding information to match the provided medical documents accurately. This includes editing codes to ensure that the claim contains accurate medical codes before submitting it to the insurance company. The claim submission process involves tedious and repetitive verification frameworks to ensure accurate information (Umari & Qaddomi, 2022). So, I will ensure that the claim is bundled correctly to increase the chances of correct reimbursement the first time.

I find the role of the medical office administrator in developing and enforcing payer relationships highly challenging due to the difficulty of the task. This role requires immense expertise in business negotiations and medical billing specifics. I can learn more about this realm by seeking positions that are challenging yet similar to my existing position. For example, I can transition from a medical office administrator position to a health insurance negotiations officer position. The FDCPA prohibits false representation or misrepresentation of the extent, nature or legal standing of the debt, or the consumer’s right to the payments to be made to the healthcare provider (Lyons, 2019). However, it allows collection of money owed, threats to sue, or sue as long as they comply with the FDCPA. Furthermore, the FDCPA law requires the MBPA to validate the debt before payment is made and within five days after the debtor is contacted.

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References

Lyons, D. J. (2019, March 14). Debt Collection for Physicians: Fair Debt Collection Practices Act and its exceptions. JD Supra. Available at: https://www.jdsupra.com/legalnews/debt-collection-for-physicians-fair-debt-23833/

Shoukat, S. (2021). Medical Billing Life Cycle. Available at: https://free*ls.com/file-I9F6I0JHST.Medical_Billing_Life_Cycle.pdf

Umari, O., & Qaddomi, R. (2022). Medical Insurance Payer Standardization: A Necessary Paradigm Shift. Frontiers in Health Services, 2. doi: 10.3389/fsal.2022.825178