In each blank, try to type in the
word that is missing. If you've
typed in the correct word, the
blank will turn green.
If your not sure what answer should be entered, press the space bar and the next missing letter will be displayed. When you are all done, you should look back over all your answers and review the ones in red. These ones in red are the ones which you needed help on. Question: Provider as payment in full whatever is paid on the claim by the payer (except for any copayment and /or coinsurance amountsAnswer: accept Question: the amount owed to a business for services or providedAnswer: receivable Question: the maximum amount the payer will reimburse for each or service, according to the patient's policyAnswer: charges Question: documented as a letter, signed by the provider, why a claim should be reconsidered for paymentAnswer: Question: the provider reimbursement directly from the payerAnswer: assignment of Question: comparing a claim to payer edits and the patient's health plan benefits to verify that the required information is to process the claim, the claim is not a duplicate, payer rules and procedures have been followed, and procedures performed or serAnswer: adjudication Question: sorting claims upon submission to collect and verify information the patient and providerAnswer: processing Question: the transmission of claims data (electronically or manually) to payers or for processingAnswer: submission Question: a completed standardized claimAnswer: clean Question: performs centralized claims processing for providers and health plans. the processing of non-standard data elements into standard data elementsAnswer: Question: also called coinsurance payment; the percentage the pays for covered services after the deductible has been met and the copayment has been paidAnswer: Question: abstract of all recent claims on each patientAnswer: data file Question: provision in group health insurance policies that prevents multiple insurers from paying benefits covered by other ; also specifies that coverage will be provided in a specific sequence when more than one policy covers the claimAnswer: of benefits (COB) Question: also called manual daily accounts receivable journal; chronologically summary of all transactions posted to patient ledgers/accounts on a specific dayAnswer: day Question: amount for which the patient is financially responsible an insurance policy provides Answer: deductible Question: remittance advice that is submitted to the provider electronically and the same information as a paper-based remittance advice; providers receive the ERA more quicklyAnswer: electronic advice (ERA) Question: financial record source document used by providers and other personnel to treated diagnoses and services rendered to the patient during the current encounterAnswer: encounter Question: person responsible for paying health care Answer: Question: contracts with a health plan and accepts whatever the plan pays for procedures or services performedAnswer: provider (PAR) Question: also called patient account record; a permanent record of all financial transactions between the patient and the practiceAnswer: ledger Question: any medical condition that was and/or treated within a specified period of time immediately preceding the enrollees effective date of coverageAnswer: condition Question: term used for an form in the physician's officeAnswer: Question: submitting CPT codes when one code should be submittedAnswer: unbundling Question: _________ means that the patient and/or insured has authorized the payer to reimburse the provider directly.Answer: of benefits Question: Providers who do not accept assignment of Medicare benefits do not receive information included on the_____, which is sent to the patient.Answer: Summary Notice Question: The transmission of claims data to payers or is called claims:Answer: Question: Which facilitates processing of claims data elements into standard data elements?Answer: Question: A of fixed-length records submitted to payers to bill for health care services is an electronic:Answer: flat file Question: What is considered a covered ?Answer: sector payers that process electronic claims Question: An electronic claim that is because of an error or omission is considered an:Answer: open Question: Which would be used to electronic claims?Answer: magnetic Question: Which supporting documentation is with submission of an insurance claim?Answer: attachment Question: is a group health insurance policy provision that prevents multiple payers from reimbursing benefits covered by other policies?Answer: coordination of Question: The of claims by clearinghouses and payers is called claims:Answer: Question: Which of the following would occur first?Answer: Health Insurance specialist completes electronic Question: Comparing the claim to edits andthe patient's health plan benefits is part of claims:Answer: adjudication Question: Which describes any procedures or service reported on a that is not included on the payer's master benefit list?Answer: benefit Question: 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 ?Answer: common data Question: Which is the amont patients pay each time they receive health care services?Answer: copayment Question: Which of the following steps occur first?Answer: clearinghouse claims data to payers Question: Which must accept whatever a payer reimburses for procedures or services ?Answer: participating Question: Which is an interpretation of the birthday rule regarding two group health insurance policies when the parents of a child covered on both are married to each other and live in the same household?Answer: the parent whose birth month and day occurs earlier in the calender year is the primary Question: Which is the financial record source document usually generated by a ?Answer: chargemaster Question: Which requires providers to make certain written disclosures all finance charges and related aspects of credit transactions?Answer: truth in act Question: Which protects collected by consumer reported agencies?Answer: fair credit reporting Question: Which is the best way to deliquent claims?Answer: verify health identification on all patients Question: is a characteristic of deliquent commercial claims awaiting payer reimbursement?Answer: the deliquent claims are resolved with the payer Question: is an example of suporting documentation?Answer: report Question: term does the CPT manual use to refer to supporting documentation?Answer: report Question: Which claim status is assigned by the to allow the provider to correct errors or omissions on the claim and resubmit for payment consideration?Answer: clean Question: The of mandating HIPAA's national standards for electronic transactions was to:Answer: improve the and effectiveness of the health care system Question: claims are more accurate because they are:Answer: checked for accuracy by software programs or a health care clearinghouse Question: Patients can be for:Answer: procedures Question: Medicare the remittance advice a:Answer: provider remittance Question: The person in whose name the insurance is issued is the:Answer: policyholder Question: The life of an insurance claim is initiated when the:Answer: health insurance completes the CMS-1500 claim Question: What is considered a financial document:Answer: superbill or encounter Question: Which federal law protects consumers against harassing or threatening calls from collectors?Answer: fair debt collection act Question: A clearinghouse that coordinates with other entities to additional services during the processing of claims is a:Answer: value-added |
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