CPB CHAPTER 9 STUDY GUIDE SOLUTIONS

CPB CHAPTER 9 STUDY GUIDE SOLUTIONS Fee schedule - answer-a list of fees physicians establish as the fair price for the services they provide. Data entry - answer-used for: demographic information, cpt, hcpcs level ii, and icd - 10 - cm codes to report the services for that encounter, payments and adjustments from insurance carriers (reduce payment delay) Verify insurance - answer-one of the best ways to avoid payment delay is to do this (reduce payment delay) Submit clean claims - answer-a claim with all of the information required to be processed. (reduce payment delay) ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 2/9 Submit claims electronically - answer-reduces clerical paperwork, cost of postage, envelopes, and forms. Supplies the practice with reports indicating claims were received, and either accepted or rejected. (reduce payment delay) Check status reports - answer-are reports sent from the payers identifying the status of the claims that were received. The report will identify each claim with the patients' names and date(s) of service and whether the claims were accepted or rejected by the payer. (reduce payment delay) Post contractual adjustments - answer-a contractual adjustment is the amount the provider agrees to accept as a participating provider with the insurance carrier. Prior authorization - answer-a requirement that a physician obtains approval from a health plan to perform a specific service/procedure or prescribe a specific medication. Without this prior approval, the health plan may not provide coverage, or pay for the service/procedure or medication. Claim scrubbers - answer-a software program that reviews claims for key components before the claims are sent to an insurance company. Will identify possible errors before the claim is submitted. ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 3/9 Accounts receivable or a/r - answer-money owed to the practice for services rendered and billed. Payments due from patients, payers, or other guarantors Daily deposits - answer-when patients are seen in the office, copayments, deductibles, coinsurance, or patient balances may be collected by the office staff. Patient payments will also come into the office by mail, along with payments from insurance companies where direct deposit is not an option. Direct deposits - answer-many of the insurance payers will pay claims with direct deposit. Once the adjudication process has been finalized, the payer will send the remittance advice (ra) to the provider and an explanation of benefits (eob) to the patient. Electronic claims - answer-can be submitted to a carrier from a provider's office using a computer with software that meets electronic filing requirements as established by hipaa claim standards. Dsl (digital subscriber line) - answer-a very high speed connection that uses the same wires as a regular telephone line. Providers install software on their computer to use a dsl service. Extranet - answer-a private computer network allowing controlled access to the payer's system. The provider has limited access to payer and patient data elements on their patients only. Internet - answer-a vast computer network linking smaller computer networks worldwide. Using the internet allows providers secure transmission of claims without the need for additional software. ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 4/9 Magnetic tape, disk, or compact disc media - answer-magnetic tape, disk, or compact disc media can be used to manually move or transmit information. For example, download the inofrmation onto a computer disc media and then this disc would be mailed to the payer. Clearinghouse report - answer-an entity that processes or facilitates the processing of claims for providers and healthcare plans. How does a clearinghouse work? - answer-a claim or a batch of claims are submitted electronically to the clearinghouse. Typically, within 24 hours the clearinghouse will send a report to the provider. This report will identify all claims sent and also all rejected claims. Timely filing - answer-the deadline for submitting a clean claim to an insurance payer. Each payer has their own timely filing limits. Audits - answer-a review and evaluation of healthcare procedures and documentation for the purpose of comparing the quality of services or products provided in a given situation. Chargemaster - answer-a master price list of all services, supplies, devices, and