Tim just started a job as a billing and coding specialist and is learning all ab
ID: 384998 • Letter: T
Question
Tim just started a job as a billing and coding specialist and is learning all about what forms to use for the physician's office he works for. Tina tells him that the office uses the universal insurance claim form, the CMS-1500. She explains that all insurance plans they provide coverage for take this form and that he must use it for all claims.
Tina further explains that although she tries her best to be accurate with all claims, sometimes the writing in a medical record is illegible or she comes across an unfamiliar term. Because she is so busy, rather than take the time to clarify the note or look up the term, she makes an educated guess and proceeds with the claim.
Do you agree or disagree with Tina’s way of filling out an insurance claim form, and why or why not?
What rules or guidelines would you suggest she follow when filling out a claim form accurately?
What are the potential consequences of her actions if her claims are not accurate?
Explanation / Answer
1. I disagree with Tina’s way of filling out an insurance claim form. This is because making an educated guess when she comes across an unfamiliar term or when the record is illegible will result in she using an incorrect entry of the insurance claim details and may result in the wrong entry into the claims database.
2. When she comes across an unfamiliar term, it is recommended that she goes through universal insurance claim process with the CMS-1500 agent catalog where the glossary of unfamiliar terms is explained which can be used to clarify the same. When the details are illegible, the document can be sent back for rescanning and re-OCR for getting the accurate details of the image.
3. The potential consequences of her actions when her claims are not accurate, following are the potential consequences of the same…
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