Chapter 4 Word Scramble

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Question	Answer
Patients can be billed for___________ but not _________.	non-covered procedures unauthorized services
Guarantor	Person responsible for paying the charges
when does the development of an insurance claim begin?	When the providers office completes and submits the CMS-1500 form
the check in procedure for a patient who is new to the providers office is __________ than a returning patient.	More extensive
Claims attachment	supporting documentation or information that is associated with a healthcare claim or patient encounter
it is necessary to submit a claims attachment when using an	unlisted CPT code
accept assignment	the provider agrees to accept what insurance allows or approves as payment in full for the claim
CMS-1500 form requires responses to standard questions pertaining to:	auto accident: secondary insurance and employment (among other things)
clean claim	contains all required data elements needed to process and pay the claim
what do you need to know to process a claim	Name and phone number of the third party payer and the name of the policy holder (among other things)
SOF	signature on file can be submitted as patient signature as long as the signature is on file in the office.
CMS-1500 form is used to .............	report professional and technical services
If a payer marks a claim with "pending" status,	the provider can respond by correcting errors and omissions on the claim and resubmit for reconsideration
appeal	a letter signed by the provider explaining why a claim should be reconsidered for payment
PAR: Participating Provider	contracts with a health insurance plan and accepts whatever the plan pays for procedures and services performed. The PAR is not allowed to bill the patients for the difference (called balance billing).
Encounter Form	the financial record source document used by healthcare providers to record treated diagnoses and services rendered to the patient during the encounter
Clearing houses process claims that are filed in a ____________ and _________.	"flat" format converted to a "standard" format
The birthday rule	a policy determination for covered children
what happens when children are covered by the insurance policy of both parents?	The birthday rule says the parents whose birthday month and day come first int he calender year holds the primary policy.
Day sheet	chronological summary of all transactions posted on a specific day
Before scheduling an appointment with a specialist,	a managed care patient must obtain a referral form their PCP or Case Manager
Gender Rule	states the father's plan is always primary when the child is covered by both parents
Primary insurance is the insurance plan...	responsible for paying health care insurance claims first
what are SOAP notes used for?	they are used in providers offices to document patients visits
What does the health information specialist have the patient do when arriving at the doctor's office?	Have the patient complete a patient registration form
Patient Account Record	computerized record of all financial transactions between patients and the pratice
Generate a separate __________ and __________ for each patient to maintain each type of information.	financial record and medical record
claim attachment	supporting documentation associated with a healthcare claim for patient encounter
The patient account record is also called the	patient ledger
electronic flat file	clearinghouse claims processing format
What two things are used by healthcare providers to record services and diagnoses rendered during the visit?	superbill and encounter form
chargemaster	hospital financial record source document
NonPAR is a physician who is.....	NOT contracted with an insurance company
Modifier	reported on claims to provide clarification about procedures and services performed
VAN	Value-added Network; clearinghouse that involves vendors like banks, in the processing of claims
examples of covered entities	Private sector health plans Managed Care Organizations ERISA-covered benefit plans Government health plans Healthcare clearinghouses Providers that submit or receive claims electronically
_________ insurance pays first and ________________pays after that.	Primary Secondary

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