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The Claims Process - Set 2

NCCT Reviewer
STUDY
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give a more accurate description
When coding some procedures and services it is necessary to add a 2 digit modifier in order to _________?

a) indicate usual charges
b) prevent miscoding
c) give a more accurate description
d) meet federal guidelines
monitor coding accurancy
Random audits of medical records by insurance carriers are used to ___________?

a) catch errors by insurance companies
b) monitor coding accurancy
c) assess physician dictation timeliness
d) revise CPT codes
malignant lesions are reimbursed at a higher rate
It is best to delay the submission of certain claims until pathology reports are received because ___________?

a) the physician's office bills for the pathologist
b) you can never code symptoms on a claim
c) insurance companies require this
d) malignant lesions are reimbursed at a higher rate
clean claim
A correctly completed claim submitted within the policy time limit is termed a ________?

a) paper claim
b) paid claim
c) legal claim
d) clean claim
coding updates
A EOB document may include all of the following EXCEPT ________?

a) dedcutible
b) patient name
c) allowed amounts
d) coding updates
closed
Claims paid with no errors are considered ________?

a) closed
b) pending
c) filed
d) suspended
batch
A group of electronic claims submitted from one facility is termed a _______?

a) bunch
b) batch
c) cluster
d) bundle
fewer steps
From beginning to end, an electronic claim versus a paper claim requires ___________?

a) fewer steps
b) more steps
c) signature stamps
d) documents be sent
clearinghouse
A third party entity that recieves, separates, and transmits claims to the appropriate payer is called a(n) ___________?

a) carrier
b) insurance specialist
c) clearinghouse
d) national network
medically necessary
Medicaid policy allows for coverage and payment of all services that are __________?

a) billed by a physician
b) medically necessary
c) viewed as appropriate by the physician
d) less than $100
smart card
A plastic card containing information regarding a patient's insurance, history and elgibility is called ________?

a) disk
b) record
c) debit card
d) smar card
When a omission or error comes to his or her attention
When may a physician modify, change, or add an addendum to a medical record ____________?

a) Only after a claim is submitted
b) Only before a claim is submitted
c) Never
d) When an omission or error comes to his or her attention
daily
Large medical practices generally submit electronic claims _________?

a) daily
b) hourly
c) weekly
d) monthly
never printed on paper
A digital fax claim is a claim that arrives at the insurance carrier via fax machine but is _______?

a) printed on paper
b) never printed on paper
c) duplicated and verified
d) monitored by phone
fax must be turned on
In order to receive tha carrier's fax back verification, the physician's office ___________?

a) runs a test phase
b) follows a schedule
c) fax must be turned on
d) staff must be present
Handwritten information
Which of the following is NOT recommended on faxed claims ________?

a) Dark, distinct print
b) Font size of 10-14 points
c) Handwritten information
d) CMS-1500 forms
in writing
Submissions to the insurance commissioner should be handled __________?

a) electronically
b) by telephone
c) in writing
d) by the patient
carrier must pay the physician within 2 or 3 weeks
If an insurance carrier sends payment directly to the patient even though the physician has been assigned the benefits, the ____________?

a) carrier must pay the physician within 2 or 3 weeks
b) payment is not recoverable
c) patient will pay the physician
d) physician will revoke the assignment of benefits form
clean claims
The following are types of problem claims EXCEPT __________?

a) partial payment
b) clean claims
c) delinquent claims
d) suspended claims
correct dates of serice
The following are common reasons for denial of claims EXCEPT ________?

a) deleted codes
b) when gender does not match services
c) correct dates of serice
d) transposed numbers
write a letter of appeal
If a claim is denied for lack of medical necessity and the physician feels the service was medically necessary, the physician should __________?

a) contact the commissioner
b) write a letter of appeal
c) resubmit the claim
d) write off the amount of the claim
tracer
An inquiry made to locate the status of an insurance claim is called a _________?

a) follow-up
b) tracer
c) review
d) tracker