Health-care claims are a critical part of the reimbursement process. Accurate claims sent to payers mean that physicians receive the maximum appropriate payment for the services they provide. Patients are also concerned with their health-care plans, asking “How much will my insurance pay?” “How much will I owe?” “Why are these doctor's fees different from my previous doctor's fees?”

You will handle questions such as these every day. Not only must you correctly prepare health-care claims, but you will also review patients' insurance coverage, explain the physician's fees, estimate what charges payers will cover, and prepare claims for patients. This chapter prepares you for these tasks by explaining the types of healthcare insurance patients have, how payers set the charges they pay for providers' services, and how to transmit complete and accurate claims. This chapter also gives you the information you need about patients' financial responsibilities for services so that you can figure out how much patients should pay and how much will be billed to their health-care plans.