CHAPTER 30 AND 31 FUNDS EXAM
(ACTUAL UPDATE) QUESTIONS AND VERIFIED ANSWERS
NPI - ANSWER Unique 10-digit identifier for covered health care providers
CMS - ANSWER Centers for Medicare and Medicaid Services
EOB - ANSWER Document explaining payments made by the insurance company
EDI - ANSWER Electronic system required for filing electronic claims to CMS
ECT - ANSWER electronic claims sent to CMS
ASCA - ANSWER Specifies reasons a provider may submit paper claims
EMC - ANSWER method for monitoring the status & payment of insurance claims
CMS-1500 - ANSWER Standard claim form used for outpatient reimbursement
electronic claims transmission - ANSWER most common way to monitor insurance claims today
CMS 1500 - ANSWER may be filed electronically for provider medicare & medicade
reinbursement and is standard claim form used in provider offices
, Explanation of Benefits (EOB) - ANSWER received by patient & shows what insurance company
has paid
clearing house - ANSWER is a company that provides a service between providers & payers
running a claims scrub on all claims to check for missing or invalid data
in many instances, SECONDARY INSURANCE - ANSWER will pay most, if not all of the balance left
over from the primary insurance to the provider
when you SCRUB - ANSWER a claim it ensures that claims are correctly coded before being sent
to insurance company which reduces denials & increase payments to practice
what 2 things should the office claims processor have before processing a patients claim? -
ANSWER - copy patients insurance card
- signature from patient to permit release of info
explain difference between manual and electronic tracking systems - ANSWER electronic -
faster, issued online, convenient
manual- time consuming, logged in book,
list 5 pieces of information found on an EOB - ANSWER - date received
- date processed
- amount of billed charges
- charged allowed by carrier
- why service was denied
Bankruptcy - ANSWER Legal petition to the courts if one is unable to pay creditors
(ACTUAL UPDATE) QUESTIONS AND VERIFIED ANSWERS
NPI - ANSWER Unique 10-digit identifier for covered health care providers
CMS - ANSWER Centers for Medicare and Medicaid Services
EOB - ANSWER Document explaining payments made by the insurance company
EDI - ANSWER Electronic system required for filing electronic claims to CMS
ECT - ANSWER electronic claims sent to CMS
ASCA - ANSWER Specifies reasons a provider may submit paper claims
EMC - ANSWER method for monitoring the status & payment of insurance claims
CMS-1500 - ANSWER Standard claim form used for outpatient reimbursement
electronic claims transmission - ANSWER most common way to monitor insurance claims today
CMS 1500 - ANSWER may be filed electronically for provider medicare & medicade
reinbursement and is standard claim form used in provider offices
, Explanation of Benefits (EOB) - ANSWER received by patient & shows what insurance company
has paid
clearing house - ANSWER is a company that provides a service between providers & payers
running a claims scrub on all claims to check for missing or invalid data
in many instances, SECONDARY INSURANCE - ANSWER will pay most, if not all of the balance left
over from the primary insurance to the provider
when you SCRUB - ANSWER a claim it ensures that claims are correctly coded before being sent
to insurance company which reduces denials & increase payments to practice
what 2 things should the office claims processor have before processing a patients claim? -
ANSWER - copy patients insurance card
- signature from patient to permit release of info
explain difference between manual and electronic tracking systems - ANSWER electronic -
faster, issued online, convenient
manual- time consuming, logged in book,
list 5 pieces of information found on an EOB - ANSWER - date received
- date processed
- amount of billed charges
- charged allowed by carrier
- why service was denied
Bankruptcy - ANSWER Legal petition to the courts if one is unable to pay creditors
