Module 116-4/Insurance Handbook

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T/F- If a MD's office does not bill medicare and does not submit transactions electronically, directly, or through a third party, the practice is still subject to HIPPA transaction rule?

False

T/F- Medicare claim must include standard code sets, such as CPT and ICD-9 codes?

True

T/F- practice management systems can be rented from Practice management systems over the internet?

True

T/F- Insurance claims submitted electronically must have a signed agreement by the physicain with the carrier involved?

True

T/F- Clearinghouses always charge a flat fee for claim processing?

False

What is a batch?

Group of claims for different Pt. sent at the same time from one facility

What is a clearinghouse?

An entity that receives the electronic transmission of claims from the health care provider's office and translates it into a standard format prescibed in HIPPA regulations

Electronic claims are ususally paid in what time frame?

Two weeks or less

What is the most important function of a practice managment system is?

Accounts Recievable

Employers identification # is assigned by?

IRS "Internal Revenue Service'

Know what a clearinghouse does?

* Separate claims by carrier
* Perform software edits on each claim to check errors
* Transmit claims electronically to the correct insurance payer

Know where insurance claim data is gathered from?

* Before Service Rendered
* During Service Rendered
* After Service Rendered

Where should backup copies of office records be stored?

Away from the office in case of fire, flood, or theft

Know what carrier-direct is?

Medical practice has own computer system to transmitted electronically directly into the payers system.

What is an insurance billing worksheet?

Computer print out used to look for errors before an insurance claim is transmitted

Back and forth communication between user an computer that occure during online real time is called?

Interactive transaction

When keying in data it is wise to ______ frequently to save data?

Back-up

Usually a status report of claims is received _____ for the third party payer?

Electronically

Post payments in practice management system?

Daily

Note any problematic claim and resolve outstanding files?

Weekly

Batch, scrub,edit and transmit claims?

Daily and Weekly

Review claim rejection reports?

End of Month

Audit claim batched and transmitted with confirmation reports?

Daily

Make follow up call to resolve reasons for rejections?

Weekly

Review clearinghouse/payer transmission confirmation reports?

Daily

Correct rejections and resubmit claims?

Daily

Update practice management system with payer informationI?

End of Month

Research unpaid claims?

Weekly

Know the difference names for an encounter form?

Charge slip, Multipurpose billing form, Pt. service slip, routing form, super bill, transacton slip, EOB

What are medical code sets?

Data elements used uniformly to document why Pt. are seen

C ?

Carbon/Calories

*C ?

Degree Celsius

A.U.?

Both ears

b.i.d.?

Twice a day

B.S.O. ?

Bilateral Salping-OOpherectomy

B.S.E. ?

Breast self-examination

BAL ?

Broncho Alveolar Lavage

AP ?

Anteroposterior

A&P ?

Ausculatation and Percussion

CC ?

Chief complaint

cc ?

Cubic centermeter

c/o ?

Complains of

Co ?

Cobalt

BM ?

Bowel movement

BMT ?

Bone marrow transplant

CO ?

Carbon Monoxide

BE ?

Barrium enema

C02 ?

Carbon Dioxide

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