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insurance chpt 8

chapter 8 test

how often do you Review clearinghouse/payer transmission confirmation reports? Daily
how often do you audit claims batched and transmitted with confirmation reports ? Daily
how often do you correct rejections and resubmit claims? Daily
how often do you batch, scrub, edit, and transmit claims? daily or weekly
how often do you research unpaid claims? weekly
how often do you make follow-up calls to resolve reasons for rejections, such as incorrect NPI, missing patient ID, incomplete data elements, and wrong format weekly
when do you update practice management system with payer information, such as EIN, and NPI end of month
where do you store confident data? on a disk rather than only to the computers hard drive. Disk should stored in a locked secure location, preferably one that is fireproof and away from magnetic fields
what is a clearinghouse? an entity that receives the electronic transmission of claims from the health care providers office and translates it into a standard format prescribe in HIPPA
what is a batch ? Group of claims for different Pt. sent at the same time from one facility
electronic claims are usually paid in what time frame? Two weeks or less
What is the most important function of a practice management system ? Accounts receivable
employers identification # is assigned by who? IRS Internal Revenue Service
Know what a clearinghouse does Separate claims by carrier Performs software edits on each claim to check errors Transmit claims electronically to the correct insurance payer
Where is insurance claim data gathered from? before,during, and after service rendered
What is carrier-direct medical practice has own computer system to transmitted electronically directly into payers system
If a mds office does not bill medicare & does not submit transactions electronically, directly, or through a third party, the practice is still subject to HIPPA transaction rules FALSE
Medicare claim must include standard code sets, such as CPT & ICD-9 TRUE
practice management systems can be rented from practice management systems over the internet TRUE
Insurance claims submitted electronically must have a signed agreement by the physician with the carrier involved? TRUE
Clearinghouse always charge a flat fee for claim processing? FALSE
what is an insurance billing worksheet computer print out used to look for errors before an insurance claim is transmitted
Back and Forth communication between user an computer that occur during online real time is called? Interactive transaction
When keying in data it is wise to frequently what to save data? back-up
how is a status report of claims received from a third party? electronically
how often do you post payments in practice management system? Daily
how often do you note any problematic claim and resolve outstanding files ? weekly
what are the different names for an encounter form? charge slip, super bill, eob,
what are medical code sets? data elements used uniformly to document why pt are seen
Created by: deefuerte