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Questions and Answers
What is the process called when authorization is not used at the proper time?
In balance billing, who is billed if the patient is not enrolled with the secondary payer?
What can be a consequence of declaring bankruptcy?
Who is referred to as a beneficiary in health insurance?
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What does a benefit period refer to in health insurance?
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When can authorization be used if a service is postponed according to the text?
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What can be done if authorization is not used at the proper time and the service is postponed?
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What happens in balance billing if the patient is not enrolled with the secondary payer?
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In health insurance terms, who is considered a beneficiary?
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What does bankruptcy entail for an insolvent person?
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What is the result of balance billing if a patient is enrolled with a secondary payer?
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When a beneficiary enjoys benefits, who else may be covered?
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Study Notes
Authorization Issues
- Failure to use authorization at the proper time is known as "authorization not used at the proper time"
- If authorization is not used at the proper time and the service is postponed, the provider may need to resubmit the claim or obtain a retroactive authorization
Balance Billing
- If the patient is not enrolled with the secondary payer, the patient is billed
- If the patient is enrolled with the secondary payer, balance billing does not occur
Bankruptcy Consequences
- Declaring bankruptcy can be a consequence of financial insolvency
Health Insurance Terminology
- A beneficiary in health insurance refers to the person who receives the benefits of the insurance policy
- A benefit period refers to the specific timeframe during which a patient receives benefits from their insurance policy
- When a beneficiary receives benefits, dependents or spouses may also be covered depending on the policy
Authorization and Services
- Authorization can be used if a service is postponed and rescheduled for a later date
- If authorization is not used at the proper time and the service is postponed, the provider may need to resubmit the claim or obtain a retroactive authorization
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Description
Explore concepts related to back dating prior authorization and balance billing in healthcare billing. Understand the process of submitting requests for using prior authorizations at a later date and how balance billing is handled for patients with secondary payers.
