chapter 7

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AN INSURANCE CLAIM FORM THAT CONTAINS NO STAPLES OR HIGHLIGHTED AREAS AND ON WHICH THE BAR CODE AREA HAS NOT BEEN DEFORMED IS CALLED

PHYSICALLY CLEAN CLAIM

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AN INSURANCE CLAIM SUBMITTED WITH ERRORS IS REFERRED TO AS

DIRTY CLAIM

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WHEN A PT HAS DUAL COVERAGE THE INSURANCE CONSIDERED THE PRIMARY INSURANCE IS

GENERALLY THE POLICY HELD BY THE PATIENT

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OFFICE VISITS MAY BE GROUPED ON THE INSURANCE CLAIM FORM IF EACH VISIT

IS CONSECUTIVE USE THE SAME PROCEDURE CODE AND RESULTS IN THE SAME FEE

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THE NUMBER ISSUED TO PHYSICIANS AS LIFETIME 10-DIGIT NUMBER THAT REPLACE ALL OTHER NUMBER ASSIGNED BY VARIOUS HEALTH PLANS

TIN

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MEDICARE PROVIDER WHO CHARGE PT A FEE FOR SUPPLIES AND EQUIPMENT SUCH AS CRUTCHES, URINARY

A SPECIFIC DME FISCAL INTERMEDIARY

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WHEN MEDICATIONS ARE CONSIDERED TO BE EXPERMENTAL THE CLAIM SHOULD BE SENT TO THE

INSURANCE CARRIER WITH A COPY OF THE INVOICE FROM THE SUPPLY HOUSE

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OCR IS THE ACRONYM FOR

OPTICAL CHARACTER RECOGNITION

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TO CONFORM TO CMS-1500 GUIDELINES

ALL OF THE ABOVE

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THE DOCUMENT TOGETHER WITH THE PAYMENT VOUCHER THAT IS SENT TO A PHYSICIAN WHO HAD ACCEPTED

EOB

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WHEN RECEIVING PAYMENT FROM A PRIVATE INSURANCE CARRIER CHECK THE AMOUNT OF PAYMENT ON THE EOB

PT FINANCIAL ACCOUNTING RECORD

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AN INSURANCE CLAIMS REGISTER PROVIDER A

FILE CONTAINING THE NAME AND ADDRESS OF ALL INSURANCE COMPANIES

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PENDING OR RESUBMITTED INSURANCE CLAIMS MAY BE TRACKED THROUGH A FILE

TICKLER

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THERE ARE SEVERAL WAYS TO FILE PENDING INSURANCE CLAIMS WHAT IS THE BEST WAY TO FILE SO THAT TIMELY

FILE BY PT LAST NAME

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A FOLLOW UP EFFORT MADE TO AN INSURANCE COMPANY TO LOCATE THE STATUS OF AN INSURANCE CLAIM IS CALLED

BOTH A AND B ARE CORRECT

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IF AN INSURANCE CLAIM HAS BEEN LOST BY THE INSURANCE CARRIER THE PROCEDURE TO FOLLOW

ASK IF THERE IS A BACKLOG OF CLAIMS AT THE INSURANCE OFFICE

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AN EXAMPLE OF A TECHNICAL ERROR ON AN INSURANCE CLAIN

DUPLICATE DATES OF SERVICE

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WHAT SHOULD YOU DO IF AN INSURANCE CARRIER REQUEST INFO ABOUT ANOTHER INSURANCE CARRIER

PROVIDE THE INFO

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AN INSURANCE CLAIM FOR A SERVICE THAT BEEN BUNDLED WITH OTHER SERVICE WOULD BE

REJECTED

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AN INSURANCE CLAIM FOR WHICH PRIOR APPROVAL WAS NOT OBTAINED WOULD BE

DENIED

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WHAT SHOULD BE DONE IF AN INSURANCE CLAIM DENIAL IS RECEIVED BECAUSE A BILLED SERVICE WAS NOT A PROGRAM BENEFIT

REBILL WITH A LETTER OF EXPLANATION FROM THE PHYSICAIN

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WHEN DOWNCODING OCCURS PAYMENT WILL

BE LESS

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IF AN INSURANCE COMPANY ADMITS THAT A PT SIGNED AN ASSIGNMENT OF BENEFITS DOCUMENT AND THAT IT INADVERTENTLY PAID THE PT INSTEAD OF THE PHYSICIAN THE INSURANCE COMPANY SHOULD

PAY THE PHYSICIAN WITHIN 2 TO 3 WEEKS AND HONOR THE ASSIGNMENT EVEN BEFORE THE COMPANY RECOVERS ITS MONEY

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THE FIRST LEVEL OF APPEAL IN THE MEDICARE PROGRAM

REDETERMINATION

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CASH FLOW IS THE

ONGOING AVAILABILITY OF IN THE MEDICAL PRACTICE

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WHEN INSURANCE CARRIERS DO NOT PAY CLAIMS IN A TIMELY MANNER WHAT EFFECT DOSE THIS HAVE ON THE MEDICAL PRACTICE

DECREASED CASH FLOW

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WHAT DOES THE INSURANCE BILLING SPECIALIST NEED TO MONITOR TO BE ABLE TO EVALUATE THE EFFECTIVENESS OF THE COLLECTION PROCEES

ACCOUNT RECEVIABLE

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THE AVERAGE AMOUNT OF ACCOUNTS RECEIVABLE SHOULD BE TIMES THE CHARGES FOR 1 MONTH OF

1.5 TO 2

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ACCOUNT THAT ARE 90 DAYS OR OLDER SHOULD NOT EXCEED OF THE TOTAL ACCOUNT RECEIVABLE

10% TO 15%

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WHAT SHOULD BE DONE TO INFORM A NEW PT OF OFFICE FEES PAYMENT POLICIES

ALL OF THE ABOVE ARE CORRECT

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THE PT IS LIKELY TO BE MOST COOPERATIVE IN FURNISHING DETAILS NECESSARY FOR COMPLETE

BEFORE ANY SERVICE ARE PROVIED

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THE REASON FOR A FEE REDUCTION MUST BE DOCUMENTED IN THE PT

MEDICAL RECORDS

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PROFESSIONAL COURTESY MEAN

MAKING NO CHARGE TO ANYONE PT OR INSURANCE COMPANY FOR MEDICAL CARE

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WHEN COLLECTING FEES YOUR GOAL SHOULD ALWAYS BE TO

COLLECT THE FULL AMOUNT

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A MEDICAL PRACTICE HAS A POLICY OF BILLING ONLY FOR CHARGE IN EXCESS OF $50 WHEN THE MEDICAL ASSISTANT REQUEST A $45 PAYMENT FOR THE OFFICE VISIT THE PT STATES JUST BILL ME HOW SHOULD THE MEDICAL ASST RESPOND

STATE THE OFFICE POLICY AND ASK FOR THE FULL FEE

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THE MOST COMMON METHOD OF PAYMENT IN THE MEDICAL OFFICE

PERSONAL CHECK

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WHEN THE PHYSICIANS OFFICE RECEIVES NOTICE THAT A CHECK WAS NOT HONORED THE FIRST THING TO DO IS TO

CALL THE BANK OR THE PT

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ACCOUNT RECEIVABLE ARE USUALLY AGED IN TIME PERIODS

30,60,90,AND 120 DAYS

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MESSAGES INCLUDED ON STATEMENTS TO PROMOTE PAYMENT ARE CALLED

DUN MESSAGES

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WHAT IS THE TYPE OF BILLING SYSTEM IN WHICH PRACTICE MANAGEMENT SOFTWARE IS USED

COMPUTER BILLING

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EMPLOYMENT OF A BILLING SERVICE IS CALLED

OUTSOURCING

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THE FIRST STATEMENT SHOULD BE OF SERVICE

PRESENTED AT THE TIME

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THE FIRST TELEPHONE CALL TO PT TO TRY TO COLLECT ON AN ACCOUNT SHOULD BE MADE

AFTER THERE IS NO RESPONSE FROM THE THIRD STATEMENT

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WHAT IS THE NAME OF THE ACT DESIGNED TO ADDRESS THE COLLECTION PRACTICES OF THIRD PARTY DEBT COLLECTORS AND ATTORNEY WHO REGULARLY COLLECT DEBTS FOR OTHERS

FAIR DEBT COLLECTION PRACTICES ACT

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WHICH GROUP OF ACCOUNTS WOULD A COLLECTOR TARGET WHEN HE OR SHE BEGINS MAKING TELEPHONE CALLS

60-TO-90 DAYS ACCOUNT

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IN MAKING COLLECTION TELEPHONE CALLS A GROUP OF ACCOUNTS HOW SHOULD THE ACCOUNTS BE ORGANIZED TO DETERMINE WHERE TO BEGIN

ORGANIZE THE ACCOUNTS ACCORDING TO AMOUNT OWED AND START WITH THE LARGEST AMOUNT

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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

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WHEN WRITING A COLLECTION LETTER

USE A FRIENDLY TONE AND WHY PAYMENT HAS NOT BEEN MADE

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IF AN INSURANCE COMPANY SEEMS TO BE IGNORING ALL EFFORTS TO TRACE A CLAIM SEND A COPY OF THE

HISTORY OF THE ACCOUNT

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NETBACK IS A TERM USED TO DESCRIBE

A COLLECTION AGENCYS PERFORMANCE

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THE PART OF THE LEGAL SYSTEM THAT ALLOWS LAYPEOPLE TO SETTLE A LEGAL MATTER WITHOUT USE OF AN ATTORNEY

SMALL CLAIMS

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IN A BANKRUPTCY CASE MOST MEDICAL BILLS ARE CONSIDERD

UNSECURED DEBT

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WHICH TYPE OF BANKRUPTCY IS CONSIDERED WAGE EARNER BANKRUPTCY

CHAPTER 13

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THE UNPAID BALANCE DUE FROM PT FOR SERVICE THAT HAVE BEEN RENDERED IS CALLED

ACCOUNT RECEIABLE

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THE PT INFO SHEET IS ALSO KNOWN AS THE

PT RESGISTRATION INSURANCE FORM

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ASSETS OR DEBT THAT HAVE BEEN DETERMINED TO BE UNCOLLECTIBLE AND ARE THEREFORE TAKEN OFF THE ACCOUNTING BOOKS AS LOSS ARE CALLED

WRITE OFF

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DOCUMENTATION FROM PRIVATE INSURANCE CARRIERS SENT TO PARTICIPATING PROVIDERS THAT ACCOMPANIES PAYMENT AND DESCRIBES THE RESPONSE TO A CLAIM IS REFERRED BY THE ACRONYM

EOB

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FTC STAND FOR

FEDERAL TRADE COMMISSION

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ALL REQUESTS OF THE INSURANCE COMMISSIONER MUST BE SUBMITTED IN WRITING AND INCLUDE THE

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A DELINQUENT INSURANCE CLAIM MAY BE EASILY LOCATED BY REVIEWING THE

INSURANCE CLAIMS REGISTER

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AN INSURANCE CLAIM THAT IS PENDING BECAUSE OF THE NEED FOR ADDITIONAL INFO IS ALSO REFEERED TO CONSIDERED

REJECTED CLAIM

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THE OBJECTIVE OF THE ADMINISTRATIVE SIMPLIFICATION COMPLIANCE ACT WAS TO IMPROVE THE ADMINISTRATION OF THE MEDICAL PROGRAM BY INCREASED EFFICIENCIES RESULTING FROM

ELECTRONIC CLAIM SUBMISSION

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THE PAPER CLAIM FORM WAS REVISED IN 2005 TO ALLOW REPORTING OF _ FOR PHYSICANS

NPI

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A CLAIM THAT IS SUBMITTED TO THE INSURANCE CARRIER VIA INTERNET CONNECTION IS REFERRED TO AS

ELECTRONIC CLAIM

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