In this week’s module we will learn:
Module Three (3) examines claims processing and the appeals process. The module will also cover a brief history of claims processing and discusses form completion and governmental payers.
- Examine third-party policies to determine payer-mix and reimbursement.
- Assess claims processing and the appeals process to achieve timely reimbursement.
- Evaluate governmental payer types for compliance with rules and regulations.
Please make sure to read the Module 3 Lecture and associated textbook readings listed in Module 3. This information will help you when developing your Discussion Board 3 posting. You will need to substantiate your answers to the Discussion Board 3 questions. Remember to use correct APA formatting when citing sources.
What is due this week:
Discussion Board Post for Module 3
This week’s topic. Make sure you address each question
- In your post, compare and contrast various payers and suppliers and the claims filing process. Who are the main payers (i.e. insurance companies) within our healthcare industry? Make sure you compare and contrast these payers. Make sure you talk about the claim filing process. What type of claim form is submitted by a hospital? What types of claim form is submitted by a professional provider?
- How important are ethics with claims processing? Please make sure to include information on ethics and why it is important for providers/facilities to be compliant with the claims filing process. Students have missed this piece in previous courses.
- Explain how ethics can impact payer mix and reimbursement. Take the payer mix you compared and contrast in the first bullet to help answer this question. Ask yourself…Why should a payer/insurance company be ethical? What is the impact to providers if the payer/insurance company does not follow a certain standard?
- In response to your peers, support their position with additional ideas and concepts from the module’s readings. Offer a potential problem that could arise when dealing with claims filing.
Review the question(s) posted for this discussion board. Refer to the Assignments and Rubric link on the left-hand side of the Blackboard course. This will provide you with details on grading criteria.
You will need to post 1 initial post that contains your response to the discussion board question for Module 3. This should be between one to two paragraphs. The initial post is due by Thursday by 11:59 p.m.
Providing your professional and/or your personal opinion is completely acceptable in the discussion board forum; however, as a requirement of the grading rubric and for this course you must substantiate your initial post with resources. The resources can include any readings from the week’s module or information from other trusted websites (i.e. Centers for Medicare and Medicaid, news articles, AHIMA, etc.). Please make sure you cite within the body of your text in correct APA format. Your references should also be in APA format as well. If you’re unsure of proper APA format, please email me. I am more than happy to assist you with this task.
Additionally, you need to reply to two (2) students at a minimum for this discussion board post for week 3. The two responses need to be posted in the discussion board forum by Sunday by 11:59 p.m. for week 3 in order to receive credit.
The optional discussion board to the week 3 topic has been posted. The information I provide is to help facilitate this week’s learning objectives. Again, this is optional and if you chose to reply, your response will count as 1 student reply.