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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
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AN INSURANCE CLAIM SUBMITTED WITH ERRORS IS REFERRED TO AS
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chapter 7
| Question | Answer |
|---|---|
| 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 |
| AN INSURANCE CLAIM SUBMITTED WITH ERRORS IS REFERRED TO AS | DIRTY CLAIM |
| WHEN A PT HAS DUAL COVERAGE THE INSURANCE CONSIDERED THE PRIMARY INSURANCE IS | GENERALLY THE POLICY HELD BY THE PATIENT |
| 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 |
| THE NUMBER ISSUED TO PHYSICIANS AS LIFETIME 10-DIGIT NUMBER THAT REPLACE ALL OTHER NUMBER ASSIGNED BY VARIOUS HEALTH PLANS | TIN |
| MEDICARE PROVIDER WHO CHARGE PT A FEE FOR SUPPLIES AND EQUIPMENT SUCH AS CRUTCHES, URINARY | A SPECIFIC DME FISCAL INTERMEDIARY |
| 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 |
| OCR IS THE ACRONYM FOR | OPTICAL CHARACTER RECOGNITION |
| TO CONFORM TO CMS-1500 GUIDELINES | ALL OF THE ABOVE |
| THE DOCUMENT TOGETHER WITH THE PAYMENT VOUCHER THAT IS SENT TO A PHYSICIAN WHO HAD ACCEPTED | EOB |
| WHEN RECEIVING PAYMENT FROM A PRIVATE INSURANCE CARRIER CHECK THE AMOUNT OF PAYMENT ON THE EOB | PT FINANCIAL ACCOUNTING RECORD |
| AN INSURANCE CLAIMS REGISTER PROVIDER A | FILE CONTAINING THE NAME AND ADDRESS OF ALL INSURANCE COMPANIES |
| PENDING OR RESUBMITTED INSURANCE CLAIMS MAY BE TRACKED THROUGH A FILE | TICKLER |
| THERE ARE SEVERAL WAYS TO FILE PENDING INSURANCE CLAIMS WHAT IS THE BEST WAY TO FILE SO THAT TIMELY | FILE BY PT LAST NAME |
| 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 |
| 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 |
| AN EXAMPLE OF A TECHNICAL ERROR ON AN INSURANCE CLAIN | DUPLICATE DATES OF SERVICE |
| WHAT SHOULD YOU DO IF AN INSURANCE CARRIER REQUEST INFO ABOUT ANOTHER INSURANCE CARRIER | PROVIDE THE INFO |
| AN INSURANCE CLAIM FOR A SERVICE THAT BEEN BUNDLED WITH OTHER SERVICE WOULD BE | REJECTED |
| AN INSURANCE CLAIM FOR WHICH PRIOR APPROVAL WAS NOT OBTAINED WOULD BE | DENIED |
| 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 |
| WHEN DOWNCODING OCCURS PAYMENT WILL | BE LESS |
| 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 |
| THE FIRST LEVEL OF APPEAL IN THE MEDICARE PROGRAM | REDETERMINATION |
| CASH FLOW IS THE | ONGOING AVAILABILITY OF IN THE MEDICAL PRACTICE |
| WHEN INSURANCE CARRIERS DO NOT PAY CLAIMS IN A TIMELY MANNER WHAT EFFECT DOSE THIS HAVE ON THE MEDICAL PRACTICE | DECREASED CASH FLOW |
| WHAT DOES THE INSURANCE BILLING SPECIALIST NEED TO MONITOR TO BE ABLE TO EVALUATE THE EFFECTIVENESS OF THE COLLECTION PROCEES | ACCOUNT RECEVIABLE |
| THE AVERAGE AMOUNT OF ACCOUNTS RECEIVABLE SHOULD BE TIMES THE CHARGES FOR 1 MONTH OF | 1.5 TO 2 |
| ACCOUNT THAT ARE 90 DAYS OR OLDER SHOULD NOT EXCEED OF THE TOTAL ACCOUNT RECEIVABLE | 10% TO 15% |
| WHAT SHOULD BE DONE TO INFORM A NEW PT OF OFFICE FEES PAYMENT POLICIES | ALL OF THE ABOVE ARE CORRECT |
| THE PT IS LIKELY TO BE MOST COOPERATIVE IN FURNISHING DETAILS NECESSARY FOR COMPLETE | BEFORE ANY SERVICE ARE PROVIED |
| THE REASON FOR A FEE REDUCTION MUST BE DOCUMENTED IN THE PT | MEDICAL RECORDS |
| PROFESSIONAL COURTESY MEAN | MAKING NO CHARGE TO ANYONE PT OR INSURANCE COMPANY FOR MEDICAL CARE |
| WHEN COLLECTING FEES YOUR GOAL SHOULD ALWAYS BE TO | COLLECT THE FULL AMOUNT |
| 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 |
| THE MOST COMMON METHOD OF PAYMENT IN THE MEDICAL OFFICE | PERSONAL CHECK |
| 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 |
| ACCOUNT RECEIVABLE ARE USUALLY AGED IN TIME PERIODS | 30,60,90,AND 120 DAYS |
| MESSAGES INCLUDED ON STATEMENTS TO PROMOTE PAYMENT ARE CALLED | DUN MESSAGES |
| WHAT IS THE TYPE OF BILLING SYSTEM IN WHICH PRACTICE MANAGEMENT SOFTWARE IS USED | COMPUTER BILLING |
| EMPLOYMENT OF A BILLING SERVICE IS CALLED | OUTSOURCING |
| THE FIRST STATEMENT SHOULD BE OF SERVICE | PRESENTED AT THE TIME |
| 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 |
| 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 |
| WHICH GROUP OF ACCOUNTS WOULD A COLLECTOR TARGET WHEN HE OR SHE BEGINS MAKING TELEPHONE CALLS | 60-TO-90 DAYS ACCOUNT |
| 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 |
| 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 |
| WHEN WRITING A COLLECTION LETTER | USE A FRIENDLY TONE AND WHY PAYMENT HAS NOT BEEN MADE |
| IF AN INSURANCE COMPANY SEEMS TO BE IGNORING ALL EFFORTS TO TRACE A CLAIM SEND A COPY OF THE | HISTORY OF THE ACCOUNT |
| NETBACK IS A TERM USED TO DESCRIBE | A COLLECTION AGENCYS PERFORMANCE |
| THE PART OF THE LEGAL SYSTEM THAT ALLOWS LAYPEOPLE TO SETTLE A LEGAL MATTER WITHOUT USE OF AN ATTORNEY | SMALL CLAIMS |
| IN A BANKRUPTCY CASE MOST MEDICAL BILLS ARE CONSIDERD | UNSECURED DEBT |
| WHICH TYPE OF BANKRUPTCY IS CONSIDERED WAGE EARNER BANKRUPTCY | CHAPTER 13 |
| THE UNPAID BALANCE DUE FROM PT FOR SERVICE THAT HAVE BEEN RENDERED IS CALLED | ACCOUNT RECEIABLE |
| THE PT INFO SHEET IS ALSO KNOWN AS THE | PT RESGISTRATION INSURANCE FORM |
| ASSETS OR DEBT THAT HAVE BEEN DETERMINED TO BE UNCOLLECTIBLE AND ARE THEREFORE TAKEN OFF THE ACCOUNTING BOOKS AS LOSS ARE CALLED | WRITE OFF |
| 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 |
| FTC STAND FOR | FEDERAL TRADE COMMISSION |
| ALL REQUESTS OF THE INSURANCE COMMISSIONER MUST BE SUBMITTED IN WRITING AND INCLUDE THE | PT |
| A DELINQUENT INSURANCE CLAIM MAY BE EASILY LOCATED BY REVIEWING THE | INSURANCE CLAIMS REGISTER |
| AN INSURANCE CLAIM THAT IS PENDING BECAUSE OF THE NEED FOR ADDITIONAL INFO IS ALSO REFEERED TO CONSIDERED | REJECTED CLAIM |
| 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 |
| THE PAPER CLAIM FORM WAS REVISED IN 2005 TO ALLOW REPORTING OF _ FOR PHYSICANS | NPI |
| A CLAIM THAT IS SUBMITTED TO THE INSURANCE CARRIER VIA INTERNET CONNECTION IS REFERRED TO AS | ELECTRONIC CLAIM |
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