Health Care

Explain the difference between Medicare Supplemental Insurance and Medicare Part B

Explain how Medicare works as a secondary payer

Describe the levels of the Medicare appeals process

Explain the purpose of the Early Periodic Screening Diagnosis and Treatment program (EPSDT)
Medicaid as the “payer of last resort
Guidelines for billing patients for expenses not paid by Medicaid
Managed Care
Types of managed care organizations
Reasons that a managed care plan might dis-enroll a member
Documentation a provider should include to support a disenrollment request
Purpose of re-insurance or stop-loss
Why is it important?
What are the consequences?
Handling Grievances or complaints
Primary Care Physician (PCP)
Referrals to a specialist
preauthorization/authorization
second-opinion policies
denial of services
Transferring from one primary care physician (PCP), the patient’s gatekeeper, to another PCP
How/Why individual providers terminate a contract
Filing Insurance Claims
Common errors
Difference between clean claims, dirty (unclean) claims, and rejected claims
Preventing omissions and mistakes

 

 

 

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