Module 116-4/Insurance Handbook
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?
T/F- Medicare claim must include standard code sets, such as CPT and ICD-9 codes?
T/F- practice management systems can be rented from Practice management systems over the internet?
T/F- Insurance claims submitted electronically must have a signed agreement by the physicain with the carrier involved?
T/F- Clearinghouses always charge a flat fee for claim processing?
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?
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?
When keying in data it is wise to ______ frequently to save data?
Usually a status report of claims is received _____ for the third party payer?
Post payments in practice management system?
Note any problematic claim and resolve outstanding files?
Batch, scrub,edit and transmit claims?
Daily and Weekly
Review claim rejection reports?
End of Month
Audit claim batched and transmitted with confirmation reports?
Make follow up call to resolve reasons for rejections?
Review clearinghouse/payer transmission confirmation reports?
Correct rejections and resubmit claims?
Update practice management system with payer informationI?
End of Month
Research unpaid claims?
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
Twice a day
Broncho Alveolar Lavage
Ausculatation and Percussion
Bone marrow transplant