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Health Insurance
HI chp 4
| Question | Answer |
|---|---|
| What does the acronym EFT mean? | Electronic Funds Transfer |
| What does the acronym PAR mean? | Participating Provider |
| What does the acronym ERA mean? | Electronic Remittance Advice |
| What does the acronym COB mean? | Coordination of Benefits |
| What does the acronym EDI mean? | Electronic Data Interchange |
| What is a claim called that contains all required data elements needed to process and pay the claim? | Clean claim |
| What is it called when you submit multiple CPT codes when just one code should have been submitted? | Unbundling |
| What is assigning lower-level codes than documented in the record? | Downcoding |
| What means the provider agrees to accept what the insurance company allows or approves as payment in full for the claim? | Accept Assignment |
| What means that the patient and/or insured authorizes the payer to reimburse the provider directly? | Assignment of Benefits |
| Who is the person responsible for paying the charges for the encouter? | Guarantor |
| Who contracts with a health insurance plan and accepts whatever the plan pays for procedures or services performed? | PAR-Participating Provider |
| What is a provision in group health insurance policies intended to keep multiple insurers from paying benefits covered by other policies? | COB-Coordination of Benefits |
| What in the life cycle of a claim is the transmission of claims data (electronically or manually) to payers or clearinghouses for processing? | Claims submission |
| What in a life cycle of a claim involves sorting claims upon submission to collect and verify information about the patient and provider? | Claims processing |
| What in the life cycle of a claim is the process when the claim is compared to payer edits and the patient's health plan benetits to verify various information? | Claims adjudication |
| What is the financial record source document used by health care providers, in their offices, to record treated diagnoses and services rendered to the patient during the current encounter? | Encounter form or Superbill |
| What is known as thepatient account record in a computerized system, is a permanent record of all financial transactions between the patient and the practice? | Patient Ledger |
| What is a financial record source document used in the hospital? | Chargemaster |
| What is the insurance plan responsible for paying healthcare insurance claims first? | Primary insurance |
| What is a public or private entity that processes or facilitates the processing of nonstandard data elements into standard data elements? | Clearinghouse |
| What is any medical condition that was diagnosed and/or treated within a specified period of time immediately preceding the enrollee's effective date of coverage? | Pre-existing condition |
Created by:
YTIMBC
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