25 terms

Medical Insurance Chap 7

Chapter 7 review
Who developed the standard form
Health Insurance Association and American Medical Association
Name of the insurance form approved by the American Medical Association
Health Insurance Claim Form
What form is excepted by Medicare
CMS-1500 (08-05)
When two insurances are involved-one primary,one secondary
dual coverage
What important document must you have before an insurance company can photocopy a patients chart
Authorization form
Solutions to an insurance claim returned for the reason "diagnosis incomplete"
1) Update encounter form twice a year, 2)Verify and submit correct diagnosis codes by referring to an updated diagnosis code book and review pt records, 3) check w/physcian if diagnosis code listed does not go w/proceedure code shown
If a patient brings in a private insurance form that is not group insurance, where do you send the form
To the insurance carrier
When preparing a claim that is optically scanned, birth dates are keyed in with how many digits
Difine abreviation: MG/MCG
Claim missing required information
incomplete claim
Phrase used when a claim is held back from payment
pending claim
Claim that is submitted and then optically scanned by the insurance carrier and converted to electronic form
paper claim
Claim that needs manual processing because of errors or to solve a problem
dirty claim
Claim that needs clarification and some questions answered
rejected claim
Claim that is canceled or voided if incorrect claim form is used or itemized charges are not provided
deleted claim
Claim that is submitted via telephone line or computer modem
electronic claim
Claim that is submitted within the time limit and correctly completed
clean claim
Medicare claim that contains information that is complete and necessary but is illogical or incorrect
invalid claim
A number issued by the federal goverment to each individual for personal use
Social Security number
A Medicare lifetime provider number
National Provider Identifier
A number listed on a claim when submitting insurance claims to insurance companies under a group name
Group National Provider number
A number that a physician must obtain to practice in a state
State license number
A number used for billing for supplies and equipment
Durable medicall equipment number
A number issued to a hosptial
Facility provider number
An individual physcian's federal tax identification number issued by the Internal Revenue Service
Employer Identification number