Health Ins. Chapter 4
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| show | accept assignments
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| show | accounts receivable
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| the maximum amount the payer will reimburse for each procedure or service, according to the patient's policy | show 🗑
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| documented as a letter, signed by the provider, explaining why a claim should be reconsidered for payment | show 🗑
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| the provider receives reimbursement directly from the payer | show 🗑
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| show | claims adjudication
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| show | claims processing
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| the transmission of claims data (electronically or manually) to payers or clearinghouses for processing | show 🗑
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| show | clean claim
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| performs centralized claims processing for providers and health plans. Facilitates the processing of non-standard data elements into standard data elements | show 🗑
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| also called coinsurance payment; the percentage the patient pays for covered services after the deductible has been met and the copayment has been paid | show 🗑
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| abstract of all recent claims filed on each patient | show 🗑
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| show | coordination of benefits (COB)
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| also called manual daily accounts receivable journal; chronologically summary of all transactions posted to individual patient ledgers/accounts on a specific day | show 🗑
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| amount for which the patient is financially responsible an insurance policy provides coverage | show 🗑
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| remittance advice that is submitted to the provider electronically and contains the same information as a paper-based remittance advice; providers receive the ERA more quickly | show 🗑
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| financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter | show 🗑
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| person responsible for paying health care fees | show 🗑
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| show | participating provider (PAR)
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| also called patient account record; a computerized permanent record of all financial transactions between the patient and the practice | show 🗑
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| show | preexisting condition
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| show | superbill
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| show | unbundling
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| show | assignment of benefits
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| show | Medicare Summary Notice
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| show | submission
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| show | clearinghouse
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| show | flat file format
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| What is considered a covered entity? | show 🗑
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| An electronic claim that is rejected because of an error or omission is considered an: | show 🗑
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| Which would be used to transmit electronic claims? | show 🗑
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| Which supporting documentation is associated with submission of an insurance claim? | show 🗑
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| Which is a group health insurance policy provision that prevents multiple payers from reimbursing benefits covered by other policies? | show 🗑
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| The sorting of claims by clearinghouses and payers is called claims: | show 🗑
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| Which of the following steps would occur first? | show 🗑
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| show | adjudication
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| show | noncovered benefit
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| show | common data file
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| Which is the fixed amont patients pay each time they receive health care services? | show 🗑
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| Which of the following steps would occur first? | show 🗑
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| Which must accept whatever a payer reimburses for procedures or services performed? | show 🗑
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| Which is an interpretation of the birthday rule regarding two group health insurance policies when the parents of a child covered on both policies are married to each other and live in the same household? | show 🗑
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| show | chargemaster
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| show | truth in lending act
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| Which protects information collected by consumer reported agencies? | show 🗑
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| Which is the best way to prevent deliquent claims? | show 🗑
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| show | the deliquent claims are resolved directly with the payer
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| Which is an example of suporting documentation? | show 🗑
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| show | special report
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| Which claim status is assigned by the payer to allow the provider to correct errors or omissions on the claim and resubmit for payment consideration? | show 🗑
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| show | improve the efficiency and effectiveness of the health care system
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| Electronic claims are more accurate because they are: | show 🗑
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| show | noncovered procedures
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| show | provider remittance notice
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| show | policyholder
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| show | health insurance specialist completes the CMS-1500 claim
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| What is considered a financial source document: | show 🗑
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| show | fair debt collection practices act
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| show | value-added network
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