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HIPAA AND REIMBURSEM
Chap 8-10
| Question | Answer |
|---|---|
| The exchange of data in a standardized format through computer connections is known as electronic data interchange? | True |
| A Medicare claim must include standard code sets, such as CPT and ICD-9-CM codes? | True |
| Insurance billing specialists who handle checks or cash should be bonded and insured? | True |
| Insurance companies are rated according to the number of complaints received abouth them? | True |
| In order to submit insurance claims electronically, a signed agreement by the physician with the carriers involved is necessary? | True |
| Clearinghouses always charge a flat fee for claim processing? | False |
| Insurance claims transmitted electonically are usually paid in ___________? | 2 weeks or less |
| The most important function of a Practise Management System (PMS) is ____________? | Accounts receivable |
| The employer's Identification number is assigned by whom? | The Internal Revenue Service. |
| A clearinghouse performs what functions? | Transmits claims to the insurance payer; Performs software edits; Separates claims by carrier. |
| Insurance claims form data are gathered when? | Before the service is rendered; During the time the service is rendered; After the service is rendered. |
| A status report of claim is usually received_________? | Electronically |
| For assignement of benefits, each patient's ___________ must be obtained? | Signature (SOF) |
| A screen prompt is a _____________? | Question |
| When should you post payments in the PMS? | Daily |
| When should you note any problamatic claims and resolve outstanding files? | Weekly |
| When should yo batch, scrub, edit and transmit claims? | Daily or weekly |
| When should you review all claim rejection reports? | End of month |
| When should you audit claims batched and transmitted with confirmation reports? | Daily |
| When should you make follow-up calls to resolve reasons for rejections? | Weekly |
| When should you review clearinghouse/payer transmission reports? | Daily |
| When should you correct rejection and resubmit claims? | Daily |
| When should you you update the PMS with payer information? | End of Month |
| When should you research unpaid claims? | Weekly |
| Time limits stated in individual health insurance policies about an insurance company's obligation to pay benefits are the same for all insurance companies? | False |
| There is standardization of format for the Explanation of Benefits (EOB) document for all private insurance carriers? | False |
| The insurance industry is protected by a special exemption from the Federal Trade Commission (FTC). | True |
| Insurance companies are rated according to the number of complaints received about them. | True |
| Pending or resubmitted insurance claims may be tracked through a ___________? | Tickler File |
| If an insurance claim has been lost by the insurance carrier, trhe procedure(s) to follow is to __________? | Ask if there is a backlog of claims at the insurance company. |
| What should you do if an insurance carrier requests information about another insurance carrier? | Provide the information (Remember TPO) |
| When downcoding occurs, payment will? | Be less |
| If the medical practise receives payment from an insurance company that is more than the contract rate, it is called a/an _______? | Overpayment |
| Generally, if a bill has not been paid, the physician rebills the patient every________ days. | 30 days |
| A large percentage of reimbursement in the physician's office is generated from third-party payers. | True |
| Information provided on the patient registration form will prove critical to any billing and collections efforts. | True |
| When no business or home telephone number is listed on the patient registration form, this may be an indication of a future nonpaying patient. | True |
| A collection rate of 80% to 85% should be the goal for the practise administrator in charge of collections in the physician's office. | False. |
| In trying to collect an unpaid balance, a telephone interview is preferred to a personal interview. | False |
| A personal check is a guarantee of payment. | True |
| Insurance billing specialists who handle checks or cash should be bonded and insured. | True |
| The patient is likely to be the most cooperative in furnishing details necessary for a complete registration process when? | BEFORE any services are provided. |
| What does Professional courtsey mean? | Making no charge to anyone, patient or insurance company, for medical care. |
| Employment of a billing service is called a________? | Outsourcing |
| What is a card called that permits bank customers to make cashless purchases from funds on deposit without incurring revolving finance charges for credit? | Debit card |
| Whic group of accounts would a collector target when he/she begins making telephone calls? | 60-90 day accounts. |
| A plan in which employees can choose their own working hours from within a broad range of hours approved by management is called? | Flex time |
| The patient information sheet is also known as the? | Patient registration information form. |
| In dealing with an estate claim, a call to the ________________ can be made periodically to check on the status of the estate. | Executor |
Created by:
douelt
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