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Comprehensive Health Insurance: Billing, Coding, Reimbursement; Chapter 11 Study Guide
Terms in this set (20)
The person who is ultimately responsible for paying for the healthcare services rendered.
Define Assignments of Benefits form.
Request made by a patient to allow the insurance carrier to pay the healthcare professional directly rather than issuing monies to the patient.
Define Release of Information form.
Specifies which information from a patient's medical chart may be released and to whom it may be released.
How often should the medical office request that the patient sign and update a release information form?
Once a year
A company that receives claims from multiple providers, evaluates them, and batches them for electronic submission to multiple insurance carriers.
What is listed on an Audit-Edit report from a clearinghouse?
- Claims that need correction
- Claims that have missing information
- Claims forwarded to insurance carriers
Process of "scrambling" information during the time it is being transmitted by rotating letters in the alphabet and/or numbers.
Pertaining to the CMS-1500 form, what does the acronym OCR refer to?
Optical Character Recognition
Who issues the Employer Identification number or federal tax ID number?
Internal Revenue System (IRS)
What is the identification number issued to physicians who are authorized to practice medicine in a given state?
State License Number
Define dirty claim.
A claim that is incorrect or is missing information when submitted.
Explain the Birthday rule.
Determines which insurance is primary when two policies are valid for a child. The plan of the parent whose birthday comes first in the calendar year is usually primary.
When will Coordination of Benefits be used?
When determining how claims will be paid by each insurance plan.
Define Supplemental Insurance.
Providers coverage for medical services not covered by the primary plan. An example of supplemental insurance would be a Medigap policy that pays the insurance coinsurance and items not covered by Medicare.
Who developed the CMS-1500 claim form?
Centers for Medicare and Medicaid Services (CMS)
What is the subsection of HIPAA that regulates electronic billing?
Who are covered entities according to HIPAA?
Health plans, clearinghouses, billing services, and providers.
On the CMS-1500 claim form, what does EMG mean?
On the CMS-1500 claim form, what does NPI stand for?
National Provider Identifier
On the CMS-1500 claim form, what does EIN stand for?
Employer Identification Number
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