12 Questions
What is the process called when authorization is not used at the proper time?
Back Dating
In balance billing, who is billed if the patient is not enrolled with the secondary payer?
The Patient
What can be a consequence of declaring bankruptcy?
Worsened Credit Rating
Who is referred to as a beneficiary in health insurance?
Person Covered by Health Insurance
What does a benefit period refer to in health insurance?
Duration of Health Coverage
When can authorization be used if a service is postponed according to the text?
If Approved by the Insurance
What can be done if authorization is not used at the proper time and the service is postponed?
Request insurance to use the same authorization
What happens in balance billing if the patient is not enrolled with the secondary payer?
The balance is billed to the patient
In health insurance terms, who is considered a beneficiary?
Person covered by health insurance
What does bankruptcy entail for an insolvent person?
Loss of control over bank accounts and future financial options
What is the result of balance billing if a patient is enrolled with a secondary payer?
The balance is billed to the primary payer
When a beneficiary enjoys benefits, who else may be covered?
Dependents
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
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.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
