Name examples of NPP's (non-physician practitioners).

Physician assistant, nurse practictioner, certified nurse anesthetist, physical therapist, speech therapist, LCSW, certified registered nurse practicioner.

Name 3 job titles available after training in diagnostic and procedural coding & insurance claims completion.

Insurance billing specialist Medical Billing respresentative Reimbursement specialist

Name some responsibilities & duties an ins billing rep may perform in general as well as performing collections.

Abstracts health info from patient records Operates computer to create & transmit claims Acts as a link between the provider & third-party payers Insurance counselor to patients Bills secondary insurance and patients Updates knowledge

List the duties of claims assistance professional.

Help patients organize, file & negotiate health claims Assist consumer in getting maximum benefits Tells patients how much to pay providers to avoid overpayment.

List 4 reasons for a medical practices large accounts receivable.

1. Failure to verify insurance benefits 2. Failure to obtain authorization or pre-certification 3. Failure to collect copays and deductibles 4. Inadequate claims filing

Name some skills required for an insurance billing specialist.

Knowledge of medical terminology, anatomy & physiology Expert use of procedural and diagnostic codes Precise reading skills Basic math Knowledge of compliance, billing & collection techniques Basic keyboarding & computer skills Generate claims

Define medical ethics.

Standards of conduct by which an insurance billing specialist determines the propriety or his/her behavior in a relationship.

Define vicarious liability also known as respondent superior.

When a physician is legally responsible for an employee;s conduct performed during employment.

What type of insurance is needed if a claims assistant neglects to submit an insurance claim to a Medicare supplement insurance within the proper time limit?

Errors and omissions insurance.

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Ability to input data & transmit insurance claims accurately directly or thru clearinghouse as well as maintain and update software applications as required by third-party payers is technical skill required of what job?

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Name some facilities where facility billing is used.

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Wookbook Chap 1

Role of Ins Billing Specialist

Question	Answer
Ability to input data & transmit insurance claims accurately directly or thru clearinghouse as well as maintain and update software applications as required by third-party payers is technical skill required of what job?	Electronic Claims Processor
Name some facilities where facility billing is used.	Hospitals, acute care hospitals, skilled nursing & long term care facilities, rehabilitation centers & ambulatory surgical centers.
Name examples of NPP's (non-physician practitioners).	Physician assistant, nurse practictioner, certified nurse anesthetist, physical therapist, speech therapist, LCSW, certified registered nurse practicioner.
Name 3 job titles available after training in diagnostic and procedural coding & insurance claims completion.	Insurance billing specialist Medical Billing respresentative Reimbursement specialist
Name some responsibilities & duties an ins billing rep may perform in general as well as performing collections.	Abstracts health info from patient records Operates computer to create & transmit claims Acts as a link between the provider & third-party payers Insurance counselor to patients Bills secondary insurance and patients Updates knowledge
List the duties of claims assistance professional.	Help patients organize, file & negotiate health claims Assist consumer in getting maximum benefits Tells patients how much to pay providers to avoid overpayment.
Insurance claims must be submitted within how many days to ensure continuous cash flow.	1 to 5
The amount of actual money available to the medical practice is known as what?	Cash flow
List 4 reasons for a medical practices large accounts receivable.	1. Failure to verify insurance benefits 2. Failure to obtain authorization or pre-certification 3. Failure to collect copays and deductibles 4. Inadequate claims filing
Name some skills required for an insurance billing specialist.	Knowledge of medical terminology, anatomy & physiology Expert use of procedural and diagnostic codes Precise reading skills Basic math Knowledge of compliance, billing & collection techniques Basic keyboarding & computer skills Generate claims
Define medical ethics.	Standards of conduct by which an insurance billing specialist determines the propriety or his/her behavior in a relationship.
To report incorrect information to an Aetna insurance is what?	Unethical
Reporting incorrect information to a Medicare fiscal intermediary is what?	Illegal
In certain circumstances, if two doctors treat the same patient for the same condition it may be what?	Unethical
Define vicarious liability also known as respondent superior.	When a physician is legally responsible for an employee;s conduct performed during employment.
What type of insurance is needed if a claims assistant neglects to submit an insurance claim to a Medicare supplement insurance within the proper time limit?	Errors and omissions insurance.

Created by: mpeoples

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