Health Ins. Chapter 4
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| show | accept assignments
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| the amount owed to a business for services or goods provided | show 🗑
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| the maximum amount the payer will reimburse for each procedure or service, according to the patient's policy | show 🗑
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| show | appeal
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| the provider receives reimbursement directly from the payer | show 🗑
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| comparing a claim to payer edits and the patient's health plan benefits to verify that the required information is available to process the claim, the claim is not a duplicate, payer rules and procedures have been followed, and procedures performed or ser | show 🗑
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| show | claims processing
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| show | claims submission
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| show | clean claim
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| performs centralized claims processing for providers and health plans. Facilitates the processing of non-standard data elements into standard data elements | show 🗑
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| show | coinsurance
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| show | common data file
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| show | coordination of benefits (COB)
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| show | day sheet
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| show | deductible
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| show | electronic remittance advice (ERA)
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| show | encounter form
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| person responsible for paying health care fees | show 🗑
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| show | participating provider (PAR)
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| also called patient account record; a computerized permanent record of all financial transactions between the patient and the practice | show 🗑
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| any medical condition that was diagnosed and/or treated within a specified period of time immediately preceding the enrollees effective date of coverage | show 🗑
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| term used for an encounter form in the physician's office | show 🗑
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| show | unbundling
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| _________ means that the patient and/or insured has authorized the payer to reimburse the provider directly. | show 🗑
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| show | Medicare Summary Notice
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| The transmission of claims data to payers or clearinghouses is called claims: | show 🗑
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| Which facilitates processing of nonstandard claims data elements into standard data elements? | show 🗑
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| A series of fixed-length records submitted to payers to bill for health care services is an electronic: | show 🗑
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| show | private sector payers that process electronic claims
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| An electronic claim that is rejected because of an error or omission is considered an: | show 🗑
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| show | magnetic tape
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| Which supporting documentation is associated with submission of an insurance claim? | show 🗑
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| Which is a group health insurance policy provision that prevents multiple payers from reimbursing benefits covered by other policies? | show 🗑
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| show | processing
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| show | Health Insurance specialist completes electronic claim
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| Comparing the claim to payer edits andthe patient's health plan benefits is part of claims: | show 🗑
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| Which describes any procedures or service reported on a claim that is not included on the payer's master benefit list? | show 🗑
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| Which is an abstract of all recent claims filed on each patient, used by the payer to determine whether the patient is receiving concurrent care for the same condition by more than one provider? | show 🗑
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| Which is the fixed amont patients pay each time they receive health care services? | show 🗑
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| Which of the following steps would occur first? | show 🗑
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| Which must accept whatever a payer reimburses for procedures or services performed? | show 🗑
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| show | the parent whose birth month and day occurs earlier in the calender year is the primary policyholder
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| show | chargemaster
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| show | truth in lending act
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| show | fair credit reporting act
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| show | verify health identification information on all patients
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| Which is a characteristic of deliquent commercial claims awaiting payer reimbursement? | show 🗑
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| show | operative report
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| show | special report
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| show | clean claim
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| The intent of mandating HIPAA's national standards for electronic transactions was to: | show 🗑
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| show | checked for accuracy by billing software programs or a health care clearinghouse
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| Patients can be billed for: | show 🗑
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| show | provider remittance notice
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| The person in whose name the insurance policy is issued is the: | show 🗑
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| show | health insurance specialist completes the CMS-1500 claim
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| What is considered a financial source document: | show 🗑
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| show | fair debt collection practices act
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| show | value-added network
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