If you practice in a no-fault state, this information applies to you. Each state must implement either a tort system or a no-fault system. The insurance that is available to your patients is determined by which system your state uses. The many variations of the no-fault system make it difficult to provide accurate information on…
PI and Tort Tort is defined as “a wrongful act or an infringement of a right (other than under contract) leading to civil legal liability.” For example, an automobile accident where one driver hurts another driver because he or she was not paying attention, might be considered a tort. Nearly every state has mandatory car…
Personal Injury (PI) refers to a very specific type of case. This tutorial is an overview of the ins and outs of Personal Injury coverage. A clinic will see how the patient’s insurance coverage can impact their power to seek treatment of choice and the provider’s ability to receive payment.
Sometimes, just when you think you have a solid understanding of the billing process, something comes along and throws you off. The Personal Injury claim process can be a bit challenging to understand. The image below provides a nice overview of the entire process from the time a clinic verifies the claim as a valid claim to payment and explanation of benefits
Download Reference Documents This course provided an overview of types of commercial health insurance plans and the importance of locating the payer’s medical review policies. The reference documents listed below are samples of medical policies from a variety of common payers. Use these documents as a guide to track down similar forms on payer websites….
Commercial Health Insurance FAQs Q: What is a Managed Care Organization? A: Managed care health plans are ones in which patients have covered benefits with certain doctors and hospitals. Health care providers and medical facilities enter into contracts to provide care for members at reduced costs. These contracted providers make up the plans’ networks. The…
Impact on Reimbursement Make no mistake, the Medical Review Policy (MRP) matters and it plays a key role in determining the care that is reimbursable by a payer. The MRP is an administrative and educational tool designed to help providers, physicians, and suppliers submit correct claims for payment. Medical Review Policies outline how contractors review…