Procedure Posting Routines

1. Name the three steps involved in the claims management process.
2. Provide examples where paper claims might be necessary over electronic claims submissions.
3. There are a number of items insurance companies require in order to process medical billing claims.  List at least eight (8) of these items.
4. Describe the NPI number, implementation advantages of it NPI number, and what type of provider must use the NPI.
5. Describe two specific factors that greatly reduce denied claims and limits the amount of insurance follow-up and tracing to be done.
6. Describe some ways reimbursement may be affected by a patient who receives services from an out-of-network provider.
7. Give examples of times when Medicare is the secondary payer (MSP).
8. A patient with Medicare is working at a small business with fewer than 20 employees.  She has a group plan with this employer.  Which insurance is primary for services?  Explain your answer.

• Medicare
• Employer group plan

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