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CHAPTER 5,15,6,7,8.9
REVIEW FOR TEST
| Question | Answer |
|---|---|
| A major innovation that made the process of health insurance claims submission simpler was the development of? | A universal form |
| The front side of the CS-1500 claim form is printed in? | OCR scannable RED ink |
| The most common FORMAT used for TEXT FILES in computers and on the internet is? | ASCII |
| OCR formatting rules specify? | All entries in uppercase; NO punctuation; MM/DD/YYYY birth date format |
| A "SMALL PROVIDER" of services is one with less than? | 25 full-time equivalent employees |
| The patient inforation form is considered a legal document and should be updated no less than? | Once a year |
| A patients name, address, Social Security number and employment data are commonly referred to as? | Demographic information |
| An individual covered under Medicare is referred to as a(an)? | Beneficiary |
| An insurance policy that covers an individual, his or her spouse, and eligible dependents is referred to as a(an)? | Family plan |
| A multipurpose form used by most practices for billing is called a(an)? | Superbill; encounter form or routing form |
| In noncomputerized practices, patient charges and payments can be tracked manually on a(an)? | Patient ledger card |
| How many blocks does the CMS-1500 claim form have? | 33 |
| After the health insurance professional has completed the claim form, it should be? | Proofread |
| An example of a method for manual claims follow-up is using an? | Insurance log and Insurance register |
| A company that recieves claims, consolidates them, and transmits the in batches to third-party payers is called a? | Clearinghouse |
| OCR is? | Optical character recognition |
| What are the 2 major sections of the CMS-1500 claim form? | Top portion is for the patient, bottom portion is for the physician. |
| When the health insurance professional hs completed the claim form, it is crucial that the form is thoroughly examined for? | Errors and omissions |
| What is the health insurance professional's MOST important task? | To obtain the maximum amount of reimbursment in the minimum amount of time that the medical record supports. |
| Who uses the paper CMS-1500 form? | Providers who are not computerized & unable to transmit electronically and SMALL providers with less than 25 full time employees or less than 10 in a doctor's office |
| ASCA prohibits HHS from paying Medicare claims that are NOT submitted electronically, unless the secretary grants a(an)? | Waiver |
| Define a "SMALL PROVIDER". | Has less than 25 full time employees or lessthan 10 in a doctor's office. |
| What are 3 reasons healthcare facilities use patient information form. | To gather all necessary demographic informationTo have a record of current insurance info for claims,To keep health records up-to-date. |
| What is the signifigance of a patient "ASSIGNING BENEFITS"? | Authorizes insurance company to send payment directly to helthcare professional. |
| The type of insurance that comprises a group of providers who share the fincial risk of the plan or who have an incentive to deliver cost-effective, but quality service is a(an)? | Managed care plan |
| The amount of money the policyholder has to pay out-of-pocket for any one incident or in any 1 year is limited by? | Insurance cap |
| The government health insurance program that provided coverage for it's own civilian employee's is called? | Federal Employees Health Benefits Program (FEHB) |
| The federal law designed to protect the rights of beneficiaries of employee benefit plans offered by employers and that sets minimum standards for pension plans in private industry is called? | Employee Retirement Income Security Act (ERISA) |
| A person or organization that processes claims and performs othe contractual administrative services is commonly referred to as? | Third Party Administrator (TPA) |
| Name 4 basic types of insurance plans | Traditional FFS/Indemnity plans, Preferred Provider Organizations(PPO's), Point Of Service Plans (POS), Health Maintennce Organizations (HMO's) |
| What are 3 out-of-pocket costs that are standard for patients to pay with FFS plans? | Premium; Deductible; Cost Sharing/Coinsurance |
| What is a "CARVE OUT"? | Eliminating a certain specialty of health services fromm coverage undef the healthcare policy. (ex..Mental Health) |
| What is meant by "TIMELY FILING" relating to claims? | Filing claims within time alotted will avoid claims being denied. |
| Timely filing for Blue Cross and Blue Shield claims is? | 4 Month's (120 days) |
Created by:
Jeannie-Snyder
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