Receive relevant procedural information from extern specialists if any
9
Approval: CPT Code Selection
10
Calculate Patient's financial responsibility
11
Bill Insurance Company
12
Approval: Insurance Billing
13
Check Insurance Payment
14
Contact Patient for Payment of the balance
15
Record all the procedures and transactions for the visit
16
Close the patient's file for the day
Patient Check-in
Welcome the patient to the practice and assist them with the check-in process. This task sets the tone for the patient's visit and ensures accurate record-keeping. The desired result is a smooth check-in experience for the patient and updated patient information in the system. Have you encountered any challenges during check-in before? If so, how did you resolve them?
1
English
2
Spanish
3
French
4
Mandarin
5
Arabic
Verify Patient's Insurance
Confirm the patient's insurance details to ensure coverage and correct billing. This task is crucial for financial reimbursement and avoiding billing errors. How can you verify the patient's insurance? What documentation do you need to collect?
Perform Medical Examination
Conduct a comprehensive medical examination of the patient to assess their condition. This task allows for accurate diagnosis and treatment planning. What are the necessary steps to perform a thorough medical examination? How do you communicate with the patient during the process?
1
Blood Pressure
2
Heart Rate
3
Respiration Rate
4
Temperature
5
Oxygen Saturation
1
Head and Neck
2
Cardiovascular
3
Respiratory
4
Abdominal
5
Musculoskeletal
1
1
2
2
3
3
4
4
5
5
Finalize Diagnosis
Analyze the patient's medical history, examination findings, and test results to determine a diagnosis. This task is crucial for developing an appropriate treatment plan. How do you approach diagnosing patients? What resources do you consult?
Select Applicable ICD-10 Codes
Assign the relevant ICD-10 codes to the diagnosis. These codes are used for billing and insurance purposes. Why is it important to select accurate and specific codes? How do you find the appropriate codes?
1
A00-B99
2
C00-D49
3
D50-D89
4
E00-E89
5
F01-F99
Approval: ICD-10 Code Selection
Will be submitted for approval:
Select Applicable ICD-10 Codes
Will be submitted
Select Applicable CPT Codes
Choose the appropriate CPT codes for the medical services provided during the visit. These codes determine the reimbursement rates. How do you ensure accurate coding? What resources do you use to find the correct codes?
1
Evaluation and Management
2
Anesthesia
3
Surgery
4
Radiology
5
Pathology and Laboratory
Receive relevant procedural information from extern specialists if any
Collaborate with external specialists to gather relevant procedural information. This ensures coordination of care and accurate billing. Who do you typically communicate with outside the practice? How do you request and receive information from them?
Approval: CPT Code Selection
Will be submitted for approval:
Select Applicable CPT Codes
Will be submitted
Receive relevant procedural information from extern specialists if any
Will be submitted
Calculate Patient's financial responsibility
Determine the patient's financial responsibility for the visit, including copayments, deductibles, and coinsurance. This prevents billing errors and ensures accurate payment collection. What factors influence the patient's financial responsibility? What calculations do you use?
Bill Insurance Company
Submit the claim to the insurance company for reimbursement. This process involves accurate coding and documentation. How do you ensure timely and accurate claim submission? What software or systems do you use?
Approval: Insurance Billing
Will be submitted for approval:
Bill Insurance Company
Will be submitted
Check Insurance Payment
Review the payment received from the insurance company and reconcile it with the billed amount. This ensures accurate reimbursement and identifies any discrepancies. What steps do you take to reconcile payments? How do you handle payment discrepancies?
Contact Patient for Payment of the balance
Inform the patient about their financial responsibility and request payment for the remaining balance after insurance coverage. This task ensures timely payment and facilitates accurate financial records. How do you communicate the balance to the patient? What payment options are available?
Record all the procedures and transactions for the visit
Document all the procedures performed and transactions related to the patient's visit. This ensures accurate record-keeping and supports future reference. How do you document procedures and transactions? What software or tools do you use?
Close the patient's file for the day
Wrap up the patient's visit and ensure all necessary documentation is completed. This task contributes to the overall organization and efficiency of the practice. What steps do you take to close the patient's file? How do you ensure all required information is documented?
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