Claims

Discussion Question

What skills do you feel are necessary to have in order to answer patients’ questions about claims sufficiently? Be specific and provide examples.
discussion#2

Discussion Question:

Research the reasons behind the enactment of ERISA, and explain what is it, what it does, and who benefits? Now look at your current employer, are you covered under ERISA? What is your plan for retirement especially with state and federal budget constraints and political debates over social security benefits, Medicare, and Medicaid?

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Sample Discussion Responses

Discussion 1

The following are the skills that are necessary for a nurse to have to answer patients’ questions regarding claims. One of the skills is knowledge of health insurance terminology. It is essential for nurses to be familiar with common health insurance terms to understand and explain concepts related to claims to patients (Colón-Morales et al., 2021). Some of the terminologies healthcare professionals should understand include out-of-pocket maximum, copayment, deductible, and provider network. These terms can help the nurse explain to patients the issues to do with their claims.

The second skill is communication and active listening. Nurses should have effective listening and communication skills so that they can comprehensively and concisely explain claims questions to patients (Gutiérrez-Puertas et al., 2020). Active listening lets the nurses grasp patients’ concerns and respond properly. For instance, a patient might want to know why a certain service was not covered, and active listening will help the nurse understand the patient, and effective communication will help them provide responses.

The third skill is claim processing expertise. Proficiency in understanding procedures to process a claim is important. This includes understanding documentation requirements, claim submission steps, and the typical timeline for claim processing. The skill will help the nurse properly explain to the patient claims processing procedures. The last skill is empathy. Understanding the patient’s emotions and feelings regarding claims processes is vital (Gutiérrez-Puertas et al., 2020).

Empathy will prevent the nurse from being judgmental and make the patient free to talk their mind. The last skill is problem-solving and analytical skills. Strong analytical skills can help a nurse provide a detailed interpretation of complex claims details and identify any discrepancies or errors.

References

Colón-Morales, C. M., Giang, W. C., & Alvarado, M. (2021). Informed decision-making for health insurance enrollment: survey study. JMIR Formative Research, 5(8), e27477.

Gutiérrez-Puertas, L., Márquez-Hernández, V. V., Gutiérrez-Puertas, V., Granados-Gámez, G., & Aguilera-Manrique, G. (2020). Educational interventions for nursing students to develop communication skills with patients: a systematic review. International Journal Of Environmental Research And Public Health, 17(7), 2241.

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The Employee Retirement Income Security Act (ERISA) was enacted in 1971. The ERISA is a federal law developed to set standards for private workers that provide employee benefit plans, including pensions, insurance, and retirement savings plans. The main reason why it has been enacted is to protect employee benefits (Schneider, 2019). The law was designed to protect employees’ interests by establishing minimum standards for their benefit plans. The law introduced rules to safeguard the welfare and retirement benefits provided by employers.

Another reason why the law was created was to impose fiduciary responsibilities on plan trustees and administrators who manage benefit plans meant for employees (Silverman, 2020). Lastly, the law was enacted to establish reporting and disclosure requirements and create a federal regulatory framework. Those benefits include employees, employers, government and regulatory agencies, and plan administrators and trustees.

I am employed at a state hospital, and thus I am covered under ERISA. My hospital’s employee benefits plans, such as retirement and health insurance plans, fall under ERISA regulations. I need to have various retirement savings options apart from state programs, considering the potential debates and constraints surrounding Medicare, Medicaid, and social security benefits.

One of my retirement plans is Employer-Sponsored Retirement Plan. The plan allows me to contribute part of my salary towards retirement savings (Silverman, 2020). I also have plans to contribute to my individual retirement account. I also plan to invest in my retirement through delivery investments.

Reference

Schneider, P. J. (2019). The impact of a general release on an executive’s right to litigate an Employee Retirement Income Security Act Claim. Journal of Financial Service Professionals, 73(5).

Silverman, S. I. (2020). US Supreme Court rules that arkansas statute regulating pbms is not preempted under the Employee Retirement Income Security Act of 1974. Health L. & Pol’y Brief, 15, 52.