Financial Procedures in a Healthcare Organization DQ

Health insurance companies provide the majority of the payment for medical services that clinics and physicians deliver. After the care has been delivered, the medical record is reviewed for completeness, codes are applied, and the billing office submits the claim to the insurance company or other third party payer for payment. There are several steps to take when submitting a claim form to the insurance company for reimbursement. The result of a clean claim is proper reimbursement for the services the facility has provided.

Discuss the following:

What does it mean to submit a clean claim?
List all of the information that is important before the claim can be submitted.
Discuss some of the reasons why a claim may be rejected.
State various reasons for the importance of a clean claim submission.
Address the consequences of not submitting a clean claim.
What steps should be taken to check the claim status?
As the practice manager, how would you ensure that the claims process results in clean claim submission and very few claim rejections.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.