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QuestionAnswer
In a health care office, the form patients fill out providing name, address, employer and health insurance information is called Pt information form
Patient-staff encounters in a medical facility leave lasting impressions. These “encounters” begin when Pt.telephones for an appointment
An assignment of benefits is an arrangement by patients to allow payments to be made directly to the provider
Most services offered by a health care facility are not tangible, meaning they cannot be seen or felt; therefore, patients look for surrogates, which include office location, size, and layout
With few exceptions, the release of information contained in a patient’s health record to a third party is prohibited by law without written consent
It is human nature for patients to want to like their physicians. For these reasons, physicians should reveal only enough information for the patient to relate to them
Over the next 30 years, the number of Americans over age ____ will double 65
What are three of the five categories of problem debtors? chronically slow debtors, forgetful debtors, fraudulent debtors
A chronological record of all patient transactions, including previous balances, charges, payments, and current balances is a daily Journal;
The Federal Truth in Lending Act (1968), Regulation Z allows for an installment payment plan of more than ____________ payments 4
A useful method of accounting for small practices that captures information at the time the transaction takes place is called one write or pegboard
If a patient has no insurance listed, the health insurance professional should inquire as to why there is no insurance card
When using patient billing software, accuracy is crucial. Additionally, in case of power fluctuation or failure, it is also crucial to create periodic backup files
Health care offices send out statements periodically; this process is typically called a billing cycle
The defendant is the party being sued
The Fair Debt Collection Practices Act addresses abusive methods by 3rd party collections
Before a small claims lawsuit can proceed, the court expects the ___________ to have explored all other avenues of settlement plaintiff
An organization that obtains or arranges for payment of money owed to a third party is a collection agency
A chronological listing of all transactions, considered the most basic of all office records general journal
The entire grouping of patient ledgers accounts receivable
A chronological accounting of a particular patient’s (or family’s) activities, including all charges and payments Pt ledger
A listing of all expenses paid out to vendors, such as building rent, office supplies, salaries, etc disbursement journal
A chronological record of all patient transactions, including previous balances, charges, payments, and current daily balances daily journal
The “core” of a practice’s financial records general ledger
A separate record some offices keep for wages and salaries payroll ledger
An explanation of benefits is often referred to as a remittance advice
Before the health insurance professional can complete and submit a health insurance claim a signed and dated release of info
An alternative to the suspension file is to record claims information on a columnar form called a insurance claims register
Services that typically require preauthorization or precertification include inpatient hospitalization
Adjudication is the process by which a claim is reviewed, payment decisions made
A common error that can cause a claim to be rejected is incorrect Pt ID, missing EIN, invalid CPT-ICD 9 code
A 9-digit number required by businesses to serve as their taxpayer identifying number is EIN
Of the various types of hearings, the one that is considered to be the most productive is the hearing on record
How frequently claims are submitted can vary depending on size of practice, office staffing, and type of claim
A written appeal request must contain beneficiaries name, medicare insurance claim number
If patients are covered by two insurance plans, the health insurance professional may have to submit a primary claim and secondary
A request for a fair hearing is pursued in one of three ways. What are the 3 ways court hearing
When a coordination of benefits situation exists, the health insurance professional should first verify which payer is primary and which is secondary
If the health insurance professional believes a claim has been wrongly denied, he or she can file an appeal
If there is a second insurance policy, block 11d on the CMS-1500 form should be check yes
The process of calling for a review of a decision made by a third-party carrier is a appeal
Under normal circumstances, the health insurance professional should verify the patient’s insurance information each time the Pt comes in
The term that applies when a patient and spouse are covered under two separate employer group policies is coordination of benifits
When a patient presents his/her insurance ID card, the health insurance professional should copy both sides of card
Time limits for submitting claims vary with insurance carriers; however, most allow 1 year
When it becomes necessary to include attachments with a paper claim, what information should appear on each document practice name, provider/group number, address, phone number
The document that provides such information as the charges allowed by the carrier, how much of the claim was applied to patient deductible, and/or why a service was reduced or denied is the EOB
If a corrected claim must be submitted for reconsideration, the health insurance professional should mark the claim corrected billing not duplicate claim
In order for Medicare to review a claim, it must include item/services appealed, date of initial determination, beneficiary name/medicare number
The first level of a Medicare appeal is called the appeal request for review
Created by: pdeal
 

 



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