Understand Health Insurance 4C

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Development of an Insurance Claim

Consumer Credit Protection Act of 1968 (Truth in Lending Act)

Requires providers to make certain written disclosures concerning all finance charges and related aspects of credit transactions (including disclosing finance charges expressed as an annual percentage rate).

Electronic Funds Transfer Act

Establishes the rights, liabilities, and responsibilities of participants in electronic funds transfer systems.

Equal Credit Opportunity Act

Prohibits discrimination on the basis of race, color, religion, national origin, sex, marital status, age, receipt of public assistance, or good-faith exercise of any rights under the Consumer Credit Protection Act.

Fair Credit and Charge Card Disclosure Act

Amended the Truth in Lending Act and requires credit and charge card issuers to provide certain disclosures in direct mail, telephone, and other applications and solicitations for open-end credit and charge accounts and under other circumstances.

Fair Credit Billing Act

Amended the Truth in Lending Act and requires prompt written acknowledgment of consumer billing complaints and investigation of billing errors by creditors.

Fair Credit Reporting Act

Protects information collected by consumer reporting agencies such as credit bureaus, medical information companies, and tenant screening services.

Fair Debt Collection Practices (FDCPA)

States that third-party debt collectors are prohibited from employing deceptive or abusive conduct in the collection of consumcer debts incurred for personal, family, or household purposes.

Past-due account, delinquent account

One that has not been paid within a certain time frame.

Delinquent claim cycle

Advances through aging periods (e.g., 30 days, 60 days, 90 days, and so on) and providers typically focus internal recovery efforts on older delinquent claims (e.g., 120 days or more).

Accounts receivable aging report

Shows the status (by date) of outstanding claims from each payer, as well as payments due from patients.

Outsource

contract out to other agencies

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