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HIPAA AND REIMBURSEM

Chap 8-10

QuestionAnswer
The exchange of data in a standardized format through computer connections is known as electronic data interchange? True
A Medicare claim must include standard code sets, such as CPT and ICD-9-CM codes? True
Insurance billing specialists who handle checks or cash should be bonded and insured? True
Insurance companies are rated according to the number of complaints received abouth them? True
In order to submit insurance claims electronically, a signed agreement by the physician with the carriers involved is necessary? True
Clearinghouses always charge a flat fee for claim processing? False
Insurance claims transmitted electonically are usually paid in ___________? 2 weeks or less
The most important function of a Practise Management System (PMS) is ____________? Accounts receivable
The employer's Identification number is assigned by whom? The Internal Revenue Service.
A clearinghouse performs what functions? Transmits claims to the insurance payer; Performs software edits; Separates claims by carrier.
Insurance claims form data are gathered when? Before the service is rendered; During the time the service is rendered; After the service is rendered.
A status report of claim is usually received_________? Electronically
For assignement of benefits, each patient's ___________ must be obtained? Signature (SOF)
A screen prompt is a _____________? Question
When should you post payments in the PMS? Daily
When should you note any problamatic claims and resolve outstanding files? Weekly
When should yo batch, scrub, edit and transmit claims? Daily or weekly
When should you review all claim rejection reports? End of month
When should you audit claims batched and transmitted with confirmation reports? Daily
When should you make follow-up calls to resolve reasons for rejections? Weekly
When should you review clearinghouse/payer transmission reports? Daily
When should you correct rejection and resubmit claims? Daily
When should you you update the PMS with payer information? End of Month
When should you research unpaid claims? Weekly
Time limits stated in individual health insurance policies about an insurance company's obligation to pay benefits are the same for all insurance companies? False
There is standardization of format for the Explanation of Benefits (EOB) document for all private insurance carriers? False
The insurance industry is protected by a special exemption from the Federal Trade Commission (FTC). True
Insurance companies are rated according to the number of complaints received about them. True
Pending or resubmitted insurance claims may be tracked through a ___________? Tickler File
If an insurance claim has been lost by the insurance carrier, trhe procedure(s) to follow is to __________? Ask if there is a backlog of claims at the insurance company.
What should you do if an insurance carrier requests information about another insurance carrier? Provide the information (Remember TPO)
When downcoding occurs, payment will? Be less
If the medical practise receives payment from an insurance company that is more than the contract rate, it is called a/an _______? Overpayment
Generally, if a bill has not been paid, the physician rebills the patient every________ days. 30 days
A large percentage of reimbursement in the physician's office is generated from third-party payers. True
Information provided on the patient registration form will prove critical to any billing and collections efforts. True
When no business or home telephone number is listed on the patient registration form, this may be an indication of a future nonpaying patient. True
A collection rate of 80% to 85% should be the goal for the practise administrator in charge of collections in the physician's office. False.
In trying to collect an unpaid balance, a telephone interview is preferred to a personal interview. False
A personal check is a guarantee of payment. True
Insurance billing specialists who handle checks or cash should be bonded and insured. True
The patient is likely to be the most cooperative in furnishing details necessary for a complete registration process when? BEFORE any services are provided.
What does Professional courtsey mean? Making no charge to anyone, patient or insurance company, for medical care.
Employment of a billing service is called a________? Outsourcing
What is a card called that permits bank customers to make cashless purchases from funds on deposit without incurring revolving finance charges for credit? Debit card
Whic group of accounts would a collector target when he/she begins making telephone calls? 60-90 day accounts.
A plan in which employees can choose their own working hours from within a broad range of hours approved by management is called? Flex time
The patient information sheet is also known as the? Patient registration information form.
In dealing with an estate claim, a call to the ________________ can be made periodically to check on the status of the estate. Executor
Created by: douelt
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