CHAPTER 11 WEEK 4 BILLING AND CODING REINBURSEENT

Question Answer
1. DEFINE GUARANTOR The person who is ultimately responsible for paying healthcare services rendered.
2. DEFINE ASSIGNMENT OF BENEFITS FORM Request made by a patient to allow the insurance carrier to pay the healthcare professional directly rather than issuing monies to patient.
3. DEFINE RELEASE OF INFORMATION FORM Specifies which information from a patient's medical chart may be released and who it may be released to.
4. HOW OFTEN SHOULD THE MEDICAL OFFICE REQUEST THAT THE PATIENT SIGN AND UPDATE A RELEASE OF INFORMATION FORM? The medical release forms are done on e a year; however, some facilities require the patient to sign the release form every six months.
5. DEFINE CLEARINGHOUSE A clearinghouse is a company that receives claims from providers, put them through a series of audits to check for errors, and then forwards them to appropriate insurance carrier in the carrier's required data format.
6. WHAT IS LISTED ON AN AUDIT-EDIT REPORT FROM A CLEARINGHOUSE? Claims that need corrections, claims that are missing information, and claims forwarded to the insurance carrier.
7. DEFINE ENCRYPTION Is the process of scrambling information during transmission so that it cannot be intercepted and read by anyone except the intended recipient.
8. PERTAINING TO THE CMS-1500 FORM, WHAT DOES THE ACRONYM OCR REFER TO? Optical character recognition.
9. WHO ISSUES THE EMPLOYER IDENTIFICATION NUMBER OR FEDERAL TAX ID NUMBER? This number is issued by the Internal Revenue Services (IRS) for income tax purposes.
10. WHAT IS THE IDENTIFICATION NUMBER ISSUED TO PHYSICIANS WHO ARE AUTHORIZED TO PRACTICE MEDICINE IN A GIVEN STATE? State license number.
11. DEFINE DIRTY CLAIM Incorrect or missing data on a claim.
12. EXPLAIN THE BIRTHDAY RULE If both parents cover dependent children under their insurance policies, the primary insurance is the policy of the parent whose date of birth occur earliest in the year.
13. WHEN WILL COORDINATION OF BENEFITS BE USED? When a patient has more than one insurance plan , the coordination of benefits will determine how much will be paid by each.
14. DEFINE SUPPLEMENTAL INSURANCE. Offers limited coverage, an Insurance plan that covers the patient's expenses that are not covered by the primary insurance policy.
15. WHO DEVELOPED THE CMS-1500 CLAIM FORM? Developed by the Centers of Medicare and Medicaid services (CMS)
16. WHAT IS THE SUBSECTION OF HIPAA THAT REGULATES ELECTRONIC BILLING? Administration Simplification Subsection
17. WHO ARE COVERED ENTITIES ACCORDING TO HIPAA? Health Plans, healthcare, clearinghouse, and certain healthcare providers.
18. ON THE CMS-1500 CLAIM FORM, WHAT DOES EMG MEAN? Emergency
19. ON THE CMS-1500 CLAIM FORM, WHAT DOES NPI STAND FOR? National Provider Identifier Number
20. ON THE CMS-1500 CLAIM FORM, WHAT DOES EIN STAND FOR? Employers Identification Number

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