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Kduvall Test

Enter the letter for the matching Answer
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1.
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
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2.
the provider receives reimbursement directly from the payer
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3.
the maximum amount the payer will reimburse for each procedure or service, according to the patient's policy
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4.
Which protects information collected by consumer reported agencies?
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5.
Patients can be billed for:
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6.
Which is the best way to prevent deliquent claims?
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7.
Which is the financial record source document usually generated by a hospital?
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8.
The sorting of claims by clearinghouses and payers is called claims:
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9.
The person in whose name the insurance policy is issued is the:
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10.
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?
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11.
What is considered a covered entity?
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12.
comparing a claim to payer edits and the patient's health plan benefits to verify that the required information is available to process the claim, the claim is not a duplicate, payer rules and procedures have been followed, and procedures performed or ser
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13.
sorting claims upon submission to collect and verify information about the patient and provider
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14.
also called coinsurance payment; the percentage the patient pays for covered services after the deductible has been met and the copayment has been paid
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15.
Which is an example of suporting documentation?
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16.
Which of the following steps would occur first?
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17.
any medical condition that was diagnosed and/or treated within a specified period of time immediately preceding the enrollees effective date of coverage
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18.
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 provider?
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19.
amount for which the patient is financially responsible an insurance policy provides coverage
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20.
submitting multiple CPT codes when one code should be submitted
A.
preexisting condition
B.
unbundling
C.
common data file
D.
assignment of benefits
E.
policyholder
F.
claims adjudication
G.
coinsurance
H.
clean claim
I.
Health Insurance specialist completes electronic claim
J.
operative report
K.
processing
L.
fair credit reporting act
M.
electronic remittance advice (ERA)
N.
private sector payers that process electronic claims
O.
verify health identification information on all patients
P.
allowed charges
Q.
claims processing
R.
deductible
S.
noncovered procedures
T.
chargemaster
Type the Answer that corresponds to the displayed Question.
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21.
An electronic claim that is rejected because of an error or omission is considered an:
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22.
Which describes any procedures or service reported on a claim that is not included on the payer's master benefit list?
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23.
Which would be used to transmit electronic claims?
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24.
the transmission of claims data (electronically or manually) to payers or clearinghouses for processing
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25.
Providers who do not accept assignment of Medicare benefits do not receive information included on the_____, which is sent to the patient.
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26.
Which is the fixed amont patients pay each time they receive health care services?
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27.
a correctly completed standardized claim
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28.
Which must accept whatever a payer reimburses for procedures or services performed?
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29.
term used for an encounter form in the physician's office
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30.
financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter

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