Health Insurance Today ch 5

27 terms by KellieB

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A universal form

A major innovation that made the process of health insurance claims submission simpler was the development of:

OCR scannable red ink

The front side of the CMS-1500 claim form is printed in:

ASCII

The most common format used for text files in computers and on the Internet is:

All entires in uppercase, No punctuation, and MM/DD/YYYY birth date format

OCR formatting rules specify:

25 full-time equivalent employees

A "small provider" of services is one with less than:

Once a year

The patient information form is considered a legal document and should be updated no less often than:

Demographic information

A patient's name, address, Social Security number, and employment data are commonly referred to as:

Beneficiary

An individual covered under Medicare is referred to as a(n):

Family plan

An insurance policy that covers an individual, his or her spouse, and eligible dependents is referred to as a(n):

Superbill, Encounter form, and Routing form

A multipurpose form used by most medical practices for billing is called a(n):

33

The CMS-1500 claim form has _____ separate blocks.

Proofread

After the health insurance professional has completed the claim form, it should be:

Insurance log and Insurance register

An example of a method for manual claims follow-up is using an:

Clearinghouse

A company that receives claims, consolidates them, and transmits them in batches to third-party payers is called a:

The American Medical Association

Responsible for creating the universal claim form known as the CMS-1500

The CMS-1500 form (Originally known as HCFA-1500) was developed for_________

The purpose of submitting Medicare claims.

The federal goverment has passed a law mandating that the Universal form be used by_________

All third party payers and medicare claims unless exempt.

What is the information for top part of the CMS-1500

Patient-Insured

What is the information for the bottom part of the CMS-1500

Physicians-Suppliers

The CMS-1500 formatting guildelines are____

Mandatory

The CMS-1500 is a univedrsal form, there are _______difference from one major payer to another

Minor

The health insurance professional's most important responsibilty is_________

To obtain the maximum amount of reimbursement in the minimal amount of time that the patients health record would support.

The HIPPA Administrative Simplication Compliance Act (ASCA) prohibits the Dept. of Health Services (HHS) from ______

paying all claims that are not submitted electronically with exceptions. (Small Provider or Health provider has no method to submit electronically)

The health insurance professional must obtain written permission from the patient to release healthcare information to whom.....

Any person, business and insurance carrier.

Abstract

To pull out or extract specific information from health records

Patient Ledger Card

Used when offices do not use patient accounting software, It is an accounting form on which professional service descriptions, charges, payments, adjustments, and current balance are posted chronologically.

Waiver

a formal (sometimes written) release from a particular rule or regulation

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