HIT Classification and Reimbursement
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| A payer’s initial processing of a claim screens for | show 🗑
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| show | patient eligibility, duplicate claims, and noncovered services.
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| A claim may be downcoded because | show 🗑
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| show | claim turnaround time.
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| What is the next step after the primary payer’s RA has been posted when a patient has additional insurance coverage? | show 🗑
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| show | within a specified time.
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| Determine what should be verified after an RA has been checked for the patient’s name, account number, insurance number, and date of service. | show 🗑
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| If a patient has secondary insurance under a spouse’s plan, what information is needed before transmitting a claim to the secondary plan? | show 🗑
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| What type of codes explain Medicare payment decisions? | show 🗑
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| Which of the following appears only on secondary claims? | show 🗑
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| show | downcode
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| show | initial processing, automated review, manual review, determination, and payment
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| During the adjudication process, if there are problems during the automated review, the claim is pulled for | show 🗑
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| show | claims examiner
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| show | clinical documentation.
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| A payer's initial claim review may reject a claim due to | show 🗑
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| A payer's automated claim edits may result in claim denial because of | show 🗑
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| show | concurrent care.
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| show | to a patient on the same date at the same place of service by two or more physicians.
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| A payer's decision regarding whether to pay, deny, or partially pay a claim is called | show 🗑
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| What is done by a payer to determine the appropriateness of medical services? | show 🗑
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| show | Payers may deny a claim when outdated codes are used.
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| The payer's processing of claims is called | show 🗑
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| show | pay, deny, or partially pay the claim.
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| Which of these HIPAA transactions is sent by a payer to answer a question about a submitted claim? | show 🗑
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| The claim turnaround time is the period between | show 🗑
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| An __________ code indicates that a request for more information has been sent. | show 🗑
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| A(n) __________ claim status category code is an acknowledgment that the claim has been received. | show 🗑
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| show | unpaid claims transmitted to payers by the length of time they remain due.
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| show | insurance aging report.
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| Prompt-pay laws govern | show 🗑
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| On an aging report, which category describes a current invoice? | show 🗑
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| A typical aging report groups payments that are due into which of these categories? | show 🗑
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| A pending claim is indicated by which claim status category code? | show 🗑
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| The payer's RA shows | show 🗑
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| show | RAs.
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| show | claim status category codes
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| show | an RA that covers a batch of processed claims.
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| show | are adjudicated.
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| show | CMS
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| show | all of these are correct.
errors on the listed claims.
denials to the listed claims
adjustments to the listed claims.
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| show | match up claims with the RA using the unique claim control number.
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| The advantage(s) of EFT for practices is(are) | show 🗑
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| The process of __________ means verifying that the totals on the RA are mathematically correct. | show 🗑
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| What does "reconciliation" mean? | show 🗑
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| Funds that are electronically transferred from a payer are directly deposited in the | show 🗑
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| The person filing an appeal is known as a(n) __________, regardless of whether that individual is a provider or a patient. | show 🗑
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| show | patient or provider who appeals the claim.
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| show | Medicare Redetermination Notice.
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| In general, how many levels are there when pursuing an appeal? | show 🗑
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| show | after a claim is rejected or paid at less than the expected amount
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| Medicare overpayments must be reported and the amount | show 🗑
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| show | state
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| show | billing the second payer.
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| show | Medicaid is the secondary payer to Medicare.
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| If a Medicare beneficiary receives treatment covered by workers' compensation, the Medicare plan is | show 🗑
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| show | secondary.
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| The abbreviation MSP stands for | show 🗑
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| If a Medicare beneficiary is covered by a spouse's employer group health plan, the Medicare plan is | show 🗑
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| show | any other insurance coverage.
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| When talking with someone other than the patient about an overdue bill, collections specialists will | show 🗑
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| show | the payments and charges that occurred on that date.
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| During collections, most practices use | show 🗑
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| show | credit information.
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| show | FDCPA.
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| Accounts might be considered uncollectible when a patient | show 🗑
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| Skip tracing increases the practice’s chances of | show 🗑
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| The practice will need to pay patient refunds if it has | show 🗑
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| show | collect overdue accounts from patients.
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| Bad debt is defined as | show 🗑
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| show | sound financial policies.
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| show | both patients and the practice staff.
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| show | zero-balance statement
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| A patient statement is | show 🗑
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| show | day sheet
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| What document is used by the medical insurance specialist to update the patient billing program with the payer's payments and the amount due from the patient? | show 🗑
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| The __________ totals the transactions that were posted to all patient ledgers on a particular business day. | show 🗑
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| The day sheet in a medical office summarizes | show 🗑
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| What is a printed bill that shows the amount a patient owes? | show 🗑
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| The patient statement shows | show 🗑
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| show | cycle billing.
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| show | at intervals during the month
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| Patients are grouped under the insurance policyholder in what type of billing? | show 🗑
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| Under the Federal Trade Commission's rules, it is illegal to | show 🗑
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| For most patients, their first notice that their bill is past due is a | show 🗑
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| show | Telephone Consumer Protection Act.
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| show | patient aging
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| show | FDCPA.
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| show | both the FDCPA and the Telephone Consumer Protection Act
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| Collections from patients are classified as consumer collections and are regulated by __________ and state laws. | show 🗑
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| show | call a patient at 8 p.m.
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| FDCPA is the abbreviation for | show 🗑
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| The job of creating and implementing the practice's collections policies is done by | show 🗑
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| show | stealing.
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| What term refers to the stealing of funds? | show 🗑
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| show | collections
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| show | collections.
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| The job of accurately recording the funds coming into and going out of the practice is done by | show 🗑
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| Which of the following employees learns and applies the correct techniques for effective follow-up of overdue accounts, as well as is most likely to work directly with patients? | show 🗑
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| Patients may agree to a(n)__________ for expensive procedures before the date of service. | show 🗑
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| Which of the following is the cost of a borrower's credit calculated as an annual rate? | show 🗑
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| When patients are scheduled to have major, expensive procedures, the practice's policy may be to set up | show 🗑
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| The __________ process is used to locate a patient who owes an account balance to the practice. | show 🗑
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| Which law modified the Fair Credit Reporting Act to protect the accuracy and privacy of credit reports? | show 🗑
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| show | an outside firm the medical practice hires.
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| FACTA is the acronym for | show 🗑
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| show | Fair Credit Reporting Act.
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| Credit bureaus supply information about | show 🗑
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| show | collect overdue accounts.
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| Which law required consumer reporting agencies to have reasonable and fair procedures? | show 🗑
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| show | means test
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| show | Bankruptcy
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| Which of the following requires a practice to follow a specific series of steps before an account can be written off? | show 🗑
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| show | monies owed by patients and payers.
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| show | bankruptcy.
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| What is the term for monies owed to a patient from the provider? | show 🗑
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| show | classified as uncollectible accounts.
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| HIPAA compliance records must be retained for how many years? | show 🗑
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| A __________ is a log of how long various types of documents must be stored for a particular practice. | show 🗑
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| show | retention schedule
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| When the hospital staff collects data on a patient who is being admitted for services, the process is called | show 🗑
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| Which of the following hospital departments has different procedures for collecting patients’ personal and insurance information? | show 🗑
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| Patient charges in hospitals vary according to | show 🗑
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| Which of these rules governs the reporting of hospital inpatient services on insurance claims? | show 🗑
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| show | complications.
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| In inpatient coding, the initials CC mean | show 🗑
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| The code 02103D4 is an example of which type of code? | show 🗑
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| Under a prospective payment system, payments for services are | show 🗑
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| The UB-04 form locator 4 requires the | show 🗑
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| show | primary
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| In medical insurance terminology, an emergency is a | show 🗑
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| Ambulatory care refers to which kind of care? | show 🗑
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| What is a special approach to caring for people with terminal illnesses? | show 🗑
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| show | ambulatory surgical unit.
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| show | Emergency care
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| show | emergency care
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| show | Hospice care
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| What type of facility is equipped for patients to stay overnight? | show 🗑
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| show | inpatient
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| show | either in a special hospice facility or a patient's home.
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| ASC is the abbreviation for | show 🗑
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| show | home health agency.
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| What category of services includes care given at home, such as physical therapy or skilled nursing care? | show 🗑
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| SNF is the abbreviation for | show 🗑
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| What type of care covers all types of health services that do not require an overnight hospital stay? | show 🗑
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| An ambulatory surgical center is a clinic that provides | show 🗑
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| show | the activities of daily living, such as bathing and eating
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| show | outpatient facility or setting.
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| show | master patient index
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| Inpatients are admitted to hospitals in a process called | show 🗑
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| A charge master contains a hospital's list of all of the following except | show 🗑
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| patient's personal and insurance information is gathered before or during hospital admission through which process? | show 🗑
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| Patients are listed in a patient register under a unique number, which makes up the | show 🗑
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| show | charge master
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| show | health information management.
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| The HIM department in hospitals conducts which of the following | show 🗑
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| show | admission, treatment, and discharge.
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| Which term is generally used for the hospital admission process? | show 🗑
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| HINN is the abbreviation for | show 🗑
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| show | complications and comorbidities
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| show | comorbidities
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| Which term describes the patient's condition that, after study, is established as the main reason for a hospital admission? | show 🗑
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| show | comorbidities
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| show | inpatient health data.
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| show | admitting diagnosis
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| Which term describes the main service performed for the condition listed as the principal diagnosis for a hospital inpatient? | show 🗑
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| show | inpatient medical coder.
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| MS-DRG is the abbreviation for | show 🗑
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| APC is a __________ payment system. | show 🗑
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| __________are complications caused by avoidable conditions that will not be reimbursed. | show 🗑
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| Each MDC is subdivided into __________ MS-DRGs. | show 🗑
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| APC is the abbreviation for | show 🗑
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| DRG is the abbreviation for | show 🗑
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| The DRG system is now called which of the following | show 🗑
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| show | inpatients.
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| Each hospital's __________ is an average of the DRG weights handled for a specific period of time. | show 🗑
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| show | all of these are factors in the rate
supply costs
geographic location
labor
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| A grouper is software used to help calculate and assign | show 🗑
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| show | CMS-1450
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| Hospitals must submit electronic claims for Medicare Part A reimbursement to MACs using the HIPAA health care claim called | show 🗑
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