Medical Billing and Reimbursement

Study Notes

Payment posting is the process of entering payment details into a billing system using EOB/ERA's and correspondence received from payers.
There are three natures of payments: full payment, overpayment, and low payment.

AR involves collecting money owed to a provider by an insurance company for services rendered to a patient.

Denial management involves managing denied claims and resolving issues to receive payment.

The timely filing limit is the time frame within which a claim must be submitted to an insurance company, which varies by insurance company, such as:
- Medicare: 365 days
- Medicaid: 90 days from date of denial or payment
- BCBS: 180 days
- And many others...

CPT codes are used to identify medical services and procedures, such as:
- Anesthesia (00100-01999)
- Surgery (10000-69990)
- Radiology (70000-79999)
- And many others...

HMO (Health Maintenance Organization) is a type of health insurance plan that provides coverage for medical services within a network of providers.
Medicare is a federal health insurance program for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD).
Medicaid is a joint federal-state program that provides health coverage to low-income individuals and families.
Tricare is a health insurance program for active duty members, retirees, and families of the uniformed services.
CHAMPVA is a health insurance program for certain eligible veterans and their families.

Claim processing involves the steps taken to process a claim, including:
- Verifying the processing date
- Determining the allowed amount and paid amount
- Verifying whether the claim was paid through EFT or check
- Requesting an ERA (Electronic Remittance Advice)

The United States has six time zones: Pacific, Mountain, Central, Eastern, Alaska, and Hawaii-Aleutian.
Daylight Saving Time (DST) typically begins on the second Sunday of March and ends on the first Sunday of November.

Various keyboard shortcuts are available in Excel, including:
- Ctrl+Shift+@ for time format
- Ctrl+Shift+# for date format
- Ctrl+Shift+$ for currency format
- And many others...