24 terms


may a "signature on file" be indicated on the cms-1500 claim form when a signed a signed assignment of benefits form is retained in the patient's health record?
is a photocopy of the cms-1500 claim form acceptable to be processed by the insurance carrier using scanning equipment
what is a "paper claim"?
submitted on paper & optically scanned, transferred to computer
should you allow a patient to send in his or her own insurance form to the insurance company?
what is health insurance claim form cms-1500 also called?
universal form(UB-04)
what is a "physically clean claim"?
insurance claim form that contains no staples or highlighted areas and on which the bar code area has not been deformed
what is a "dirty claim"?
an insurance claim that is submitted with errors
what is "OCR"?
optical character recognition
leave blank
how should blocks be treated on "ocr" cms-1500 claims forms that do not need any information?
two major sections of the cms 1500 claim form?
patient/physician section
the ocr guidlines for entering information on the cms 1500 claim form?
all capital letters, no punctuation, stay within blocks
is there more chance of advancement working in a hospital or in a private physician's office?
is it important for an insurance billing specialist to have a basic knowledge of insurance programs?
if a managed care patient is admitted for a non-emergency to a hospital without a managed care contract, when does the managed care program need to be notified by the hospital
the patient has to request the information
no, they will not
when a patient is admitted as a worker's compensation case, will the patient have a insurance card?
co-worker's, friend's & family
with whom should confidential information about patient's "never" be discussed?
appropriateness evaluation protocols(AEPs)
when criteria are used by the review agency for admission screening, what is this referred to as?
what is an "inpatient"?
patient stays 1 or more days in the hospital
if a patient who has a managed care contract is admitted to a hospital for an emergency, when does the managed care program need to be notified?
within 48 hours
quality improvement organization(QUIO)
what organization is responsible for admission review, readmission review, procedure review, day and cost oulier review, DRG validation, and transfer review?
7 days
readmission review occurs if the patient is readmitted within how many days of discharge?
day outlier
what is a review for additional medicare reimbursement called?
ICD-9 volume3
where are the classifications of surgical and nonsurgical procedures and miscellaneous therapeutic and diagnostic procedures found?
which code book is used to list procedures on outpatient hospital claims?