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Insurance Ch14-15
| Question | Answer |
|---|---|
| Medical necessity denial | Apair refusal to pay for report procedure due to medical |
| Overpayments | Improper or overpayment billing error |
| MRN | Letter from Medicare to apatite regarding as appeal |
| Insurance aging report | Analysis of how long the payer has held submit claims |
| Pending | Claim status waiting on information |
| Development | Payer attention together clinic (for the claim before payment) |
| EFT | Banking service |
| Concurrent care | Medical situation where a patient receive care from 2 or more physician in the same day |
| Determination | Payer decision on a payment |
| Guarantor billing | Sending one payment to the guarantor |
| Skip trace | process of locating a patient with a outstanding balance |
| Patient aging report | Overdue billing |
| Retention schedule | Summarize the practice of keeping policy |
| Patient refunds | When the practice over charge a patient |
| Uncollectible account | A balance the practice hasn't collected |
| Payment plan | Program set up for the patient schedule to pay |
| Cycle billing | Assign patient to a specific time of the month the patient with statement |
| Credit report | Process where the unpaid medical bills can be reviewed |
| The payer's processing of claim is called? | Adjudication |
| A payer's determination means it is going to what? | Pay deny or pay half |
| Determination means what? | Payer decision |
| A payer's automated claim edit may result in claim denial because? | Lack of eligibility, medical necessity |
| A claim that is removed from a payer's automated processing system is sent for? | Manual review |
| When a claim is pulled by a payer for a manual review, the provider may be asked to submit what? | Documentation |
| What is a CONCURRENT CARE? | When a patient sees 2 or more physicians |
| If there is a problem during the automated review during the adjustment process what would happen? | The claim is pulled for development |
| The HIPAA 835 is sent to do what? | Is sent to the payer to explain a claim payment |
| HIPAA 276 is used by the medical office for what? | The status for the claim |
| A payer's initial claim review may reject a claim due to? | Invalid policy number |
| HIPAA 276 is used by the medical offices for what | Sent by the payer for a submit claim |
| A list of claims transmitted and how long they have been in process with the payer is shown where? | Aging report |
| On the aging report, what range would show the current invoice? | 0-30 days passed due after 30 days |
| What kind of code appears on a payer's electronic reports on the progress of transmitted claims in the adjudication process? | Claim status Category code |
| If a provider has accepted assignment, who will the payer send the RA/EOB to? | Provider |
| If a provider has not accepted assignment, who will the payer send the RA/EOB to? | Patient |
| What codes might payers use to explain a determination? | All the above by CMS |
| The process of verifying that the totals on the RA/EOB are mathematically correct? | Reconciliation |
| The advantages of EFT for practice are? | Funds are available |
| The person filing an appeal is known as? | Climate or appellant |
| The first step in the Medicare appeals process is called? | Redetermination |
| Improper or excessive payments is known as? | Over payment |
| If a patient has additional insurance, after the primary payer's RA/EOB has posted what would be the next step? | Billed the Secondary insurance |
| Effective patient billing begins with? | Sound financial policy |
| A summary of financial transactions that occur each day is called? | Day Sheet |
| Printed bill that shows the amount a patient owes is called? | Statement |
| What is used by the insurance specialist to update the patient billing program with the payer's payment and the amount due from the patient? | RA/EOB |
| What type of billing spreads out the workload of mailing statements? | Cycle billing |
| Patient are grouped under the insurance policyholder in what type of billing? | Guarantor billing |
| Who creates and implement the practice's collection policy? | Billing collection manger |
| The job of accurately recording the funds that come in and out of the office is done by who? | Book keeper |
| The term collection refers to what? | Payment problems |
| What term mean stealing of funds? | Embezzlement |
| A patient's first notice that their bill is past due is usually? | Collect letter |
| The law that regulates the calling hours and collection methods is? | Telephone consumer act |
| A legal declaration of the inability to pay debts is known as? | Bankruptcy |
| An account that is determined to be uncollectible? | Bad debt |
| When a patient needs to be refunded because there were overcharged for services? | Patient refund |
| A patient's retention schedule protects? | The provider and patient |
Created by:
kayymoore
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