Here I will post a video about medical billing, AR CALLER how it functions also will explain what are the job opportunities are available for fresher to get into medical billing.
Here my way of explanation is just simple and clear, anybody can understand. Follow our youtube channel V BILLINGS
Referral Denial Management in Tamil | AR Caller Training in Tamil | Medical billing Training Tamil
https://www.youtube.com/watch?v=m175PzSmpe8 (https://www.youtube.com/watch?v=m175PzSmpe8)
Claim denied for missing/invalid REFERRAL :(BLOCK 23)
RENDERING PROVIDER:
A provider who provides actual service.
REFERRING PROVIDER/Primary Care Physician/ Family Doctor:
A provider who provides initial service.
² Questions to probe with Payer Rep:
²Claim received date?
²Claim denied date?
²Check system for referral is available or not if found give that to rep and reprocess
²Check claim image if referral# found in Block#23 give that to rep for reprocess
²If referral# not found in anyway, ask rep what is PCP (primary care physician) name and PCP phone# and get the corrected claim address and time filing limit
²Claim# and Call reference#
²Thank you.
²
***Note:
PPO & EPO plan doesn't require a referral, if the patient plan is PPO & EPO ask the rep to reprocess.
28 May 2021
REFERRAL MOCK CALL
https://www.youtube.com/watch?v=nKY3LAITtvs&list=PL5RwhjoJ5VJNVVzWNpzi7NDalFv01pW7K&index=3 (https://www.youtube.com/watch?v=nKY3LAITtvs&list=PL5RwhjoJ5VJNVVzWNpzi7NDalFv01pW7K&index=3)
REFERRAL_MOCK_CALL|US PAYER REP & AR CALLER |MEDICAL BILLING TRAINING (https://www.youtube.com/watch?v=nKY3LAITtvs&list=PL5RwhjoJ5VJNVVzWNpzi7NDalFv01pW7K&index=3)
Claim denied for missing/invalid REFERRAL :(BLOCK 23)
RENDERING PROVIDER:
A provider who provides actual service.
REFERRING PROVIDER/Primary Care Physician/ Family Doctor:
A provider who provides initial service.
² Questions to probe with Payer Rep:
²Claim received date?
²Claim denied date?
²Check system for referral is available or not if found give that to rep and reprocess
²Check claim image if referral# found in Block#23 give that to rep for reprocess
²If referral# not found in anyway, ask rep what is PCP (primary care physician) name and PCP phone# and get the corrected claim address and time filing limit
²Claim# and Call reference#
²Thank you.
²
***Note:
PPO & EPO plan doesn't require a referral, if the patient plan is PPO & EPO ask the rep to reprocess.
25 May 2021
HMO vs PPO vs POS Plans | In-Network & Out Of Network benefits |Medical billing in Tamil|AR CALLER| VBILLING
https://www.youtube.com/watch?v=NYXI_sRfX9o (https://www.youtube.com/watch?v=NYXI_sRfX9o)
HMO: Health maintenance organization: Budget-friendly plan.
It is one of the cheapest types of health insurance. It has low premiums and the deductible and fixed copay for doctor visits.
HMO is an individual plan.
In this policy, a PCP (Primary Care Physician) will be allocated.
HMO requires referral# from PCP when patient referred to get treated by a Specialist.
It covers only In-Network benefits, Out of network benefits not available.
POS: Point-of-Service: Hybrid of HMO and PPO
POS is one of the cheapest types of health insurance. It has low premiums and the deductible and fixed copay for doctor visits.
POS is an individual plan.
PCP (Primary Care Physician) will be allocated in POS,
Requires referral from PCP when patient referred to a Specialist.
Both In-Network benefits and Out of network benefits available.
PPO: Preferred Provider Organization: A high premium plan but fewer patient responsibilities.
PPO is one of the costliest types of health insurance. It has higher premiums than HMO and POS plan type. Copay and Coinsurance for in-network doctors are low.
PPO is a group policy.
PCP (Primary Care Physician) and Referral not needed.
A patient can directly meet Specialist
Both In-Network benefits and Out of network benefits available.
EPO: Exclusive Provider Organization: Lower monthly premiums but a higher deductible
If you’re looking for lower monthly premiums and are willing to pay a higher deductible when you need health care, you may want to consider an EPO plan.
EPO is a group plan
PCP (Primary Care Physician) and Referral not needed.
A patient can directly meet Specialist
It covers only In-Network benefits. Out of network benefits not available.
25 May 2021
Claim processed to CAPITATION or MANAGED CARE | Fee-for-service |AR CALLER TRAINING|V BILLINGS
https://www.youtube.com/watch?v=TyulTmrC5bY&t=381s (https://www.youtube.com/watch?v=TyulTmrC5bY&t=381s)
The wait is over, after many struggles, office works, and personal issues, I spent much time on this, yes our ebook for AR CALLER MEDICAL BILLING has been completed. I have launched it on amazon kindle for rs 350. You can read it for free if you have kindle account if not you have to purchase it for rs 350.00, but for our subscriber, I can send thru WhatsApp for just rs 200 so anybody wants it just pay Rs.200.00 thru google pay, phone pay or pay by UPI ID.
Once paid take a screenshot and send that to my WhatsApp and I will send you the copy once I verified it.
Google pay, phone pay = 9080556859
UPI ID : = 9080556859@kotak
Paytm: 9080556859@paytm
Bank details:
Kotak Mahindra
Name Vijayakumar Munusamy
Bank account# 5445416980
IFSC: KKBK0000471
MICR# 600485009
Branch Madippakkam
Insurance payment to provider methods: Fee-for-service, Capitation, Salary
Fee-for-service is a system of health insurance payment in which a doctor or other health care provider is paid a fee for each particular service rendered. The more services he does the more revenue. Financial risk-free tradition payment method.
Capitation is a fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services. When the provider signs a capitation agreement, a list of specific services that must be provided to patients is included in the contract.
25 May 2021
3Ps in American Medical Billing |Patient | Provider | Payor | V BILLINGS
youtube: https://www.youtube.com/watch?v=IE-joQ4dUb8 (https://www.youtube.com/watch?v=IE-joQ4dUb8)
Centers for Medicare & Medicaid Services:
The Centers for Medicare & Medicaid Services (CMS) is the agency within the U.S. Department of Health and Human Services (HHS) that administers the nation's major healthcare programs.
1.PATIENT(Insurer/subscriber/dependent/policyholder)
The person who gets medical services from the provider.
Other names Insurer/subscriber/dependent/policy holder
2.PROVIDER(Doctors, physicians, surgeons, technicians, hospitals, clinics, laboratories)
The individual or an organization that provides medical services to the patient
Other names Doctors, physicians, surgeons, technicians, hospitals, clinics, laboratories
3.PAYER(Insurance company)
The individual or an organization that process the claim and pays the provider for
the medical services are given to the patient.
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