Kinn's Chapter 21
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| assignment of benefits | The transfer of the patient's legal right to collect benefits for medical expenses to the provider of those services: the patient authorizes sending of the payments directly to the provider.
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| audit | A process done before claims submission to examine claims for accuracy and completeness. An audit can be performed manually, or it can be done electronically with computer billing software.
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| audit trail | The path left by a transaction when it has been completed: often referred to when tracking medical services used by patients or researching claims.
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| clean claim | an insurance claim form that has been completed correctly (no errors or omissions); clean claims can be processed and paid promptly if they meet the restrictions on covered services and blocks.
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| clearinghouse | A centralized facility to which insurance claims are transmitted
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| direct billing | A method of electronic claims submission where computer software allows a provider to submit an insurance claim directly to an insurance carrier for payment.
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| dirty claim | A claim form that contains errors or omissions; dirty claims must be corrected and resubmitted to an insurance carrier to obtain reimbursement.
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| electronic claim | a claim submitted to an insurance processing facility through a computerized medium, such as direct data entry, direct wire, dial-in telephone digital fax, or personal computer download or upload.
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| electronic data interchange (EDI) | The transfer of data back and forth between two or more entities using an electronic medium.
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| electronic (or digital) signature | A scanned signature or other such mark that is accepted as proof of approval of and/or responsibility for the content of an electronic document
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| employer identification number (EIN) | The number used by the Internal Revenue Service that identifies a business or individual functioning as a business entity for income tax reporting.
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| intelligent character recognition (ICR) | The electronic scanning of printed blocks as images and the use of special software to recognize these images (or characters) as ASCII text for upload into a computer database
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| National Provider Identifier (NPI) | A lifetime number consisting of 10 digits that Medicare will use to replace the Provider Identification Number(PIN) and the Unique Physician Identification number (UPIN).
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| paper claim | a hard copy of an insurance claim; which is completed and sent by surface mail.
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| rejected claims | Claims returned unpaid to the provider for clarification of any question; rejected claims must be corrected before resubmission.
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| Unique Provider Identification Number (UPIN) | A number assigned by fiscal intermediaries to identify providers on claims for services.
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| universal claim form | The form used to submit all government sponsored claims; also know as the CMS-1500 form. It was developed by the agency that became the Centers for Medicare and Medicaid Services (CMS) and approved by the American Medical Association (AMA).
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