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34 terms

Hit Chapter 15

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At least once a year.
The Health Insurance Proffesional should reverify patient information...
Determine which carrier is Primary.
In the case of a minor child of a divorced couple who is covered under both parent's group health plans, the health insurance professional should...
Authorization to release information.
Many medical practices include a section for the patient to sign an...
Inpatient hospitalization.
Services that typically require preauthorization or precertification include...
Proofread.
After a claim is completed, to help reduce claims rejection and delay, it is good practice first to have the claim...
Employer Identification Number (EIN)
The number that is assigned by the IRS and used as the employer identifier standard for all electronic health care transactions is the...
Insurance claim form.
The most important document in the medical insurance process is the...
Adjudication
After the claim form has been recieved by a third-party payer, it is reviewed and the carrier makes its payment decisions. This process is referred to as...
Optical character recognition (OCR) Scanner.
When the insurance carrier receives a paper claim, it is dated and the claim is processed through a(n)...
Suspension file.
A series of files set up chronologically and labeled according to the number of days since a claim was submitted is referred to as a(n)...
Insurance claims register.
A columnar form on which insurance claims are tracked is a(n)...
EOB
The document sent by the insurance carrier to the provider/patient explaining how the claim was adjudicated is called a(n)...
Downcoding.
When a carrier assigns a substitute code because a clai was submittedwith an outdated, deleted, or non existent CPT codes, it is called...
30 days.
Ideally, insurance claims should be submitted to the insurance carrier within...
Carrier
If there is any question as to the time limits for filing claims, the health insurance professional should contact the...
Secondary Insurer.
The insurance company that pays after the primary carrier is referred to as the...
The patient.
In case of dual coverage, if it is not immediately obvious which payer is primary, the health insurance proffesional should first ask...
Block 11d
If there is a second insurance policy, it is important to check "yes" in...
Coordination of Benefits
When a patient and a spouse are covered under two separate group policies , it results in what is commonly referred to as...
Medicare Secondary Payer Claims (MSP)
Claims that are submitted to another insurance company before they are sent to Medicare are called...
Appeal
The process of calling for a review of a decision made by a third party carrier is referred to as...
Disagreement arises with the carriers payment determination.
The Medicare appeal process begins when...
120 Days
A Medicare review request for part B appeals must come within...
Collect and verify accurate patient information.
Keys to successful claims; The first key is to...
Not Proofreading claims, or using out dated CPT Codes.
Two Common errors made on claims are...
EIN
Employer Identification Number is a 9 digit number assigned by employers by the IRS
4-6 weeks.
How long does a paper claim take to process?
Remittance advice (RA)
An EOB can also be called a(n)...
File an appeal until they are exhausted.
After a claim is denied you can...
Bill the patient
If all levels of appeal are exhausted the claim remains unpaid, there are no other options you must...
Primary
The longest established insurance between a couple is considered...
Redetermination
The first level of appeal is called
Twice a year
The Healthcare proffessional must verify a patients insurance...
Downcoding
Using Outdated CPT codes is considered...