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Checkpoint Eligibility, Payment, and Billing Procedures

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Checkpoint 1

Checkpoint Eligibility, Payment, and Billing Procedures
Patricia Walker
HCR 220 / Claims Preparation 1: Clean Bills of Health
Axia College of University of Phoenix
Professor Natalie Cooper
June 9, 2011

Checkpoint 2

In patient benefits eligibility there is a number of factors that could determine whether a patient is eligible for certain benefits , such as checking to see if a premium is required , if so then the patient has to pay them on time. Although eligibility for Medicaid is able to change on a monthly basics. Another is if a person has an employer – sponsored health plan, the person’s status of employment becomes a deciding factor as well as the providers’ status as an in network or out –of- network provider as being listed on the plan master list of providers.
The appropriate steps that would need to be taken if the patient insurance does not cover the plan and procedure to be done, then the healthcare provider need to inform the patient of the situation about their insurance eligibility of coverage. Therefore Ms. Smith should become aware that her delivery and prenatal care is not covered threw her insurance. So that way she could settle the financial account at that time.
The two examples that I provided below relates to the eligibility factor of Ms. Sandra Smith charges with corresponding billing transactions.
Example 1
Service to be performed Prenatal Care, estimated charge $ 1,800 date of planned service March 8, 2011 reason for exclusion insurance does not cover.
I, Sandra Smith is a patient of DR. Woods, understands that my insurance excludes prenatal care, which makes me liable for the service rendered.…...

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