Discussion Board Prompt:
Valley Dental Group is composed of three general practice dentists in the suburb of a large city. The group has a receptionist and an office manager. Most of the groups patients are from families with dental insurance. The benefits and coverages of the insurance policies are different. Some require preauthorization of all restorations, and others only require preauthorization for crowns, bridges, and dentures. Some policies have a family deductible for all dental care, whereas others have individual deductibles for non-preventive care only. The usual and customary prices that the insurance companies allow for procedures are different, so the amount the patient must pay depends on the insurance policy.
The practice has to organize the way the office handles the information flow to process insurance billing and track payments. Some of the tasks to be performed are as follow:
Verify the patients insurance company and policy number.
Keep track of deductible paid so far for family and/or family members.
Submit insurance claim for services rendered.
Determine the amount the patients insurance policy will pay for the procedure.
Collect the patients copayment and deductible before the patient leaves the office.
Follow up on insurance claims submitted that have not been paid.
Handle claim rejections and bill the patient for the amount not covered.
Collect statistics on the number of procedures done, the number of self-payments and insurance payments, the amount paid by insurance, and the number of claims rejected.
Collect statistics that measure the productivity of each dentist in the group.
Design a system to accomplish these tasks. Avoid duplication of effort and the storing of redundant data in your design. Write a discussion post detailing a design that includes the following:
1. What information must be collected?
2. What procedures are to be used to accomplish the tasks?
Must be 250 words with two cited sources in APA format
Will include textbook information below:
Textbook information
Peden, Ann H. Comparative Health Information Management, 4th edition with MindTap
Access. Cengage Learning. 2015. ISBN-13: 97803575156
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