Life Cycle of Claim
The life cycle of a medical claim can be very confusing for new staff. Each staff member plays a different part in contributing to the claim and pertinent documentation or submission of the claim. Nurses and clinical staff may not have as much to do with filling out claims forms as billers do, but they need to know what types of insurances require additional documentation and forms; front desk staff will need to know when to collect coinsurance and balance bills and when to ask for secondary insurances; coders will need to know any special coding requirements for secondary insurances. Billers will need to understand the entire cycle.
In this scenario, you are playing the role of a trainer and you will create a PowerPoint explaining the left cycle of a claim to new employees.
The first slide must include the life cycle of a claim overall. Create a SmartArt graphic to display the Life Cycle (DO NOT use an image found on the internet or in the content of the course).
How to create SmartArt graphic
In PowerPoint document, go to Insert tab
Choose SmartArt
Choose Cycle
The remaining slides should explain the Life Cycle of a Claim
Patient Pre-Registration
Establish Financial Responsibility
Patient Check-in & Check-out
Superbill (Encounter Form)
Prepare and Transmit the Claim
Monitor Payer Adjudication
Generate Patient Statement
Follow up Payments and Collections
Requirements:
The presentation should contain a minimum of 5 slides, not including Title and Reference Page
Select one of the following options for your presentation
- Narrated and converted to a video
The completed video must be a minimum of 5-6 minutes in length
Upload the video to YouTube and submit the URL for your video
How to create a video in PowerPoint and upload to YouTube
- Record Audio Narration in PowerPoint
Sample Answer
To experience this as intended, imagine opening a PowerPoint file with the following content on each slide, accompanied by the narration provided.
(Slide 1: Title Slide)
Title: Understanding the Medical Claim Life Cycle
Subtitle: A Guide for New Staff
Your Name (Trainer)Date: April 6, 2025 (Remembering current location: Kenya – though healthcare systems differ, the core cycle remains similar)
(Narration for Slide 1): “Welcome everyone! I’m [Your Name], and I’ll be your trainer today. This presentation will walk you through the entire life cycle of a medical claim. Understanding this process is crucial, no matter your role, as each of us plays a vital part in ensuring accurate and timely payment for the services we provide. Let’s start by looking at the overall journey of a claim.”
(Slide 2: The Life Cycle of a Claim – Overall)
Title: The Medical Claim Life Cycle
(SmartArt Graphic: Cycle)
- Step 1: Patient Pre-Registration
- Step 2: Establish Financial Responsibility
- Step 3: Patient Check-in & Check-out
- Step 4: Superbill (Encounter Form) Creation