Medical Billing Questions and Answers Presentations.pptx

This presentation covers essential medical billing questions and answers to help understand key concepts, processes, and challenges in the field. It includes common queries related to claim submissions, denials, rejections, insurance follow-ups, coding, and payment processing. By addressing these topics, we aim to enhance knowledge and improve efficiency in medical billing practices.

1. Medical Billing Questions and Answers Presented By: Adriel Khokhar

2. What is Medical billing? Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for services provided by healthcare providers. What is a CPT code? A CPT (Current Procedural Terminology) code is a five- digit code used to describe medical, surgical, and diagnostic services provided to patients. What is an ICD-10 code? ICD- 10 (International Classification of Diseases, 10th Edition) is a system of codes used to classify and describe diseases, conditions, and other health- related issues for billing and statistical purposes. What is a modifier in medical billing? A modifier is a two- digit code used to provide additional information about a service or procedure, such as indicating that a service was altered in some way but not changed in its definition. What is an EOB? EOB (Explanation of Benefits) is a statement provided by an insurer to explain what medical treatments and services were covered, what the insurer paid, and what the patient owes .

3. What is a copayment? A copayment is a fixed amount a patient pays out- of- pocket for a covered healthcare service, typically at the time of service. What is a deductible? A deductible is the amount a patient must pay for covered healthcare services before their insurance plan starts to pay. What is a claim? A claim is a request for payment that is submitted to an insurance company for services rendered by a healthcare provider. What is a clearinghouse in medical billing? A clearinghouse is an intermediary between healthcare providers and insurance payers that receives, processes, and forwards medical claims to the appropriate insurance company. What is a primary insurance? Primary insurance is the insurance policy that pays first when a patient has multiple insurance policies. What is a secondary insurance? Secondary insurance is the insurance that pays after the primary insurance has processed the claim and made its payment.

4. What is a denial in medical billing? A denial occurs when an insurance company refuses to pay a claim due to issues like incorrect coding, non- covered services, or a lack of medical necessity. What is a balance billing? Balance billing is when a provider bills the patient for the difference between what the insurance pays and the total charge for services rendered. What is the difference between an HMO and a PPO? An HMO (Health Maintenance Organization) requires patients to get care through a network of doctors, while a PPO (Preferred Provider Organization) allows more flexibility in choosing healthcare providers and specialists. What does "bundling" mean in medical billing? Bundling refers to grouping multiple related services together under one code for billing purposes, often to avoid separate charges for each individual service. What is a superbill ? A superbill is a detailed statement created by a healthcare provider that lists the services rendered, along with the corresponding CPT and ICD- 10 codes, used for insurance claims .

5. What is a superbill ? A superbill is a detailed statement created by a healthcare provider that lists the services rendered, along with the corresponding CPT and ICD- 10 codes, used for insurance claims. What is a preauthorization? Preauthorization is the process of getting approval from an insurance company before a certain service or procedure is performed to ensure it's covered. What is a remittance advice (RA)? A remittance advice is a document from the insurer that explains how a claim was processed and whether it was paid, denied, or adjusted. What is "upcoding "? Upcoding is the practice of assigning a higher- level code for a service than what was actually provided, which is illegal and considered fraud. What is the National Provider Identifier (NPI)? The NPI is a unique identification number assigned to healthcare providers in the U.S. for the purpose of billing and identifying providers. What is an out-of- pocket maximum? The out-of- pocket maximum is the most a patient will have to pay for covered services during a policy period (usually a year), after which the insurance pays 100%. What is a CPT code used for in medical billing ? CPT codes are used to describe medical procedures and services for the purpose of reimbursement by insurance companies.