About Claims
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| show | Auditing
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| show | Claim
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| show | Clearinghouse
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| show | 1. Patient Information
2. Verify Insurance
3. Prepare encounter form
4. Code DX & CPT codes
5. Review Linkage Protocol
6. Calculate Physician's Charges
7. Prepare claim
8. Transmit claim
9. Follow up on reimbursement
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| Developed by AMA and CMS; used by physicians and other professionals to bill outpatient services and supplies to Tricare, Medicare, some Medicaid programs, and some private insurance managed care plans. | show 🗑
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| show | Paper Claim/ CMS 1500
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| show | Electronic Claim
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| Transmitting electronic medical insurance claims from providers, in standard format (837-P), to payers using the necessary information systems is called ______________. | show 🗑
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| show | Clearinghouse
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| A claim submitted with errors or one that requires manual processing to resolve problems or is rejected for payment. | show 🗑
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| show | Clean Claim
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| show | Assignment of Benefits (Box 27 on CMS 1500 form)
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| show | Compliance Program
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| show | - Appropriateness of Codes
- Payers rules about linkage
- Documentation to support codes
- Compliance with regulation and guidelines
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Created by:
cattomko
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