chapter 8 test
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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| how often do you Review clearinghouse/payer transmission confirmation reports? | Daily
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| how often do you audit claims batched and transmitted with confirmation reports ? | Daily
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| how often do you correct rejections and resubmit claims? | Daily
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| how often do you batch, scrub, edit, and transmit claims? | daily or weekly
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| how often do you research unpaid claims? | weekly
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| how often do you make follow-up calls to resolve reasons for rejections, such as incorrect NPI, missing patient ID, incomplete data elements, and wrong format | weekly
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| when do you update practice management system with payer information, such as EIN, and NPI | end of month
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| where do you store confident data? | on a disk rather than only to the computers hard drive. Disk should stored in a locked secure location, preferably one that is fireproof and away from magnetic fields
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| what is a clearinghouse? | an entity that receives the electronic transmission of claims from the health care providers office and translates it into a standard format prescribe in HIPPA
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| what is a batch ? | Group of claims for different Pt. sent at the same time from one facility
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| electronic claims are usually paid in what time frame? | Two weeks or less
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| What is the most important function of a practice management system ? | Accounts receivable
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| employers identification # is assigned by who? | IRS Internal Revenue Service
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| Know what a clearinghouse does | Separate claims by carrier Performs software edits on each claim to check errors Transmit claims electronically to the correct insurance payer
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| Where is insurance claim data gathered from? | before,during, and after service rendered
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| What is carrier-direct | medical practice has own computer system to transmitted electronically directly into payers system
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| If a mds office does not bill medicare & does not submit transactions electronically, directly, or through a third party, the practice is still subject to HIPPA transaction rules | FALSE
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| Medicare claim must include standard code sets, such as CPT & ICD-9 | TRUE
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| practice management systems can be rented from practice management systems over the internet | TRUE
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| Insurance claims submitted electronically must have a signed agreement by the physician with the carrier involved? | TRUE
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| Clearinghouse always charge a flat fee for claim processing? | FALSE
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| what is an insurance billing worksheet | computer print out used to look for errors before an insurance claim is transmitted
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| Back and Forth communication between user an computer that occur during online real time is called? | Interactive transaction
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| When keying in data it is wise to frequently what to save data? | back-up
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| how is a status report of claims received from a third party? | electronically
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| how often do you post payments in practice management system? | Daily
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| how often do you note any problematic claim and resolve outstanding files ? | weekly
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| what are the different names for an encounter form? | charge slip, super bill, eob,
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| what are medical code sets? | data elements used uniformly to document why pt are seen
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