NHA Billing & Coding - Ch 4 - Claims Processing/Compliance Rated 100% Correct!!

djudication - the process health plans follow to examine claims and determine payment audit - a review or formal examination of a provider's accounting or a patient's medical records carrier block - data entry area located in the upper right corner of the CMS-1500 that allows for a four line address for the payer clearinghouse - edits and routes electronic claims to the insurance carrier for payment CMS-1500 - claim form used to submit paper claims for services and procedures rendered by physicians and other health care professionals on an outpatient basis continuity of care - coordinating treatment and health services between patients' health care providers covered entities - health plans, health care clearinghouses, or health care providers that conduct health information in electronic form in connection with a transaction covered by HIPAA denied claim status - claim status indicating a claim has been processed, but contained incorrect or incomplete information; a claim may also be denied for medical necessity Durable Medical Equipment (DME) - According to CMS, DME is .."equipment that can withstand repeated uses; is primarily and customarily used to serve a medical purpose; generally is not useful to a person in absence of illness or injury; and is appropriate for use in the home" DME s also referred to as durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) DMEPOS acronym for - Durable medical equipment, prosthetics, orthotics and supplies