Health Insurance Today ch 15

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Chapter 15 - The claim

The claim process begins when:

The patient first contacts the office for an appointment

The health insurance professional should reverify patient information:

Each time the patient visits the office

A section included (often at the bottom of the form) for the patient to sign an:

Authorization to release information

Service that typically requires pre-certification includes:

Inpatient hospitilization

The most important document in the medical insurance process is the:

Patient information form

The number that is assigned by the IRS and used as the employer indentifier standards for all electronic healthcare transactions is:

Employee indentification number (EIN)

After the claim has been received by a 3rd party payer, it is reviewed, and the carrier makes payment decision.

Adjudication

Document sent by the insurance carrier to the provider/patient explaining how the claim was adjudicated

EOB

Ideally, insurance claims should be submitted to the insurance carrier within:

30 days

If there is any question as to the limits for filing claims, the health insurance professional should contact the:

Carrier

Secondary Payer

The insurance company who pays after the primary carrier is referred to as:

Block 11d

If there is a second insurance policy, it is important to check "yes" in:

120 days

A medicare review request for Part B appeals must come within:

Preauthorization or Precertification

Ultamatley, it is the patients responsibility to know when and how to notify the insurance comapny for _____ or _________

not

It is ______ the health insurance professional's responsibility to document the appropriate health-related comments in the patients health record.

Accuratley

Coding ________ and knowing which coding system payors use helps avoid payment errors on claims.

Downcoding

When a carrier assigns a substitute code because a claim was submitted with outdated, deleted or nonexistent CPT codes, is called:

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