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GuntermanINS Ch 3
Patient Encounters and Billing Information
| Question | Answer |
|---|---|
| Another term for the insured is | subscriber |
| The term subscriber and guarantor mean the same as | insured |
| Insurance information is found on what form | patient information form |
| An established patient is defined as one who has seen the provider within the last | 3 years |
| Collecting patient information begins before patient appointments during | preregistration process |
| The patient is responsible to complete the documents patient information, assignment of benefits, and | medical history form |
| The assignment of benefits authorizes | the Dr to file claims for the patient and receive direct payments from the payer. |
| the document patients sign to signify that they have read and understand how the provider will protect the PHI is called | Acknowledgment of Receipt of Notice of Privacy Practices |
| NonPAR means | nonparticipating |
| What information is on the patient information form? | patient's personal and insurance information |
| A patient's insurance card shows what information? | Group ID number, date the coverage began, Member name, member id number, type of coverage, copayments/coinsurance, optional items that are covered. |
| A provider who directly treats a patient is called | direct provider |
| A provider such as a facility which tests patients as instructed by the direct provider is called | indirect provider |
| What type of patient should the front desk as whether any of the personal or insurance information has changed since the last visit? | established patient |
| What HIPAA transaction is used to check patients' insurance coverage? | Eligibility for a Health Plan |
| An initial step in establishing financial responsibility is | verify insured patients' eligibility of benefits, medical necessity of a planned service, copayment requirements |
| Another term for prior authorization is | certification |
| Which HIPAA transaction is used to get prior approval from a payer? | Referral Certification and Authorization |
| If a patient has insurance coverage under two plans, one which the pt is the policyholder and one which the pt is a dependent, the primary plan is | the pt's plan |
| If an employed pt has coverage under two insurance plans, one is the employer's plan and the other is a government plan, the primary plan is | the employer's plan |
| If a retired pt with Medicare also has coverage under a working spouse's plan, the primary plan is | the spouse's plan |
| Which HIPAA transaction is used to send information from a primary payer to a secondary payer? | Coordination of Benefits |
| Under a coordination of benefits provision, what percentage of the charge can be paid as a benefit? | 100% |
| A provider completes what form that summarizes the billing information, this is done during or right after a patient's visit? | encounter form |
| Self-pay means a patient is | uninsured |
| Practice rules for payment for medical services is found in the | financial policy |
| when you post an entry to a patient's account in the billing system it means you | enter it in the program |
| Which HIPAA transaction is sent from a payer to a provider after claim adjudication | Health Care Payment |
| direct provider is one who | treats the patient |
| authorization by a policyholder that allows a payer to pay benefits directly to a provider | assignment of benefits |
| insurance plan that pays benefits after payment by the primary payer when a pt is covered by more than one medical insurance plan | secondary insurance |
| the encounter form is | used to summarize the treatments and services a pt receives during visits |
| the insured is | policyholder, guarantor, or subscriber |
| the coordination of benefits is | a clause in an insurance policy that explains how the policy will pay if more than one insurance policy applies to the claim |
| document given to the patient who makes a payment | walkout receipt |
Created by:
monicagunterman