Sections
The third section contains information about ...?
Physician/Supplier
Block 4 contains whose name?
Who is the Insured's name
The process of determining if a procedure or service is covered by the insurance plan and what the reimbursement is for that service is
What is precertification
What is done with the difference between what a provider has charged for a service and the allowed amount by the insurance company?
What is written off.
The percentage of cost of covered healthcare services that the patient (and insurance company) pays after the deductible has been met.
What is coinsurance.
The first section of the claim form contain information about ...?
the Carrier
Block 17 contains what information?
What is the Name of ordering or referring provider.
A process done before claims are submitted to the insurance company to ensure accuracy and completeness.
What is audit.
The money that a business owes to vendors or payroll is?
What is accounts payable (A/P)
What is the form that the provider receives that indicates the allowed amount, patient responsibility and paid amount?
What is the RA (Remittance Advice)
The second section contains information about the...?
Patient and Insured
What completed form is required in order to put "SIGN on FILE" in block 12?
What is the ROI
An identifier assigned by the CMS that classifies the healthcare provider by license and specialties.
What is an NPI or national provider identifier.
What is the term for the contracted amount that the provider accepts as payment for services rendered?
What is the allowed amount.
What is the name of the form that is issued by healthcare providers and facilities to notify patients when Medicare will deny the claim?
What is the ABN (Advance Beneficiary Notice)
If a patient is active military, which box would be checked in section 1?
What is TRICARE
What information is entered into block 24d?
What is the CPT codes
Software that finds common billing errors before the claim is sent to the insurance company is known as
Calculate the coinsurance for: Mrs. Jones incurs a bill of $9,500. Her deductible has already been satisfied. Her coinsurance is 90/10. What does Mrs. Jones have to pay?
What is $950.
What is the list of fixed fees for services the office/clinic/provider performs?
What is the Fee Schedule
In section 2, the person who is primary on the insurance is the..?
Who is the Insurer/Insured
What is entered into block 23?
What is the prior authorization number.
A payment arrangement for providers where they are paid a set amount for each enrolled patient per set period regardless if patient received services or not.
What is capitation.
Truth in Lending Act mandates that the provider gives the patient an APR, monthly interest rate, total cost to the borrower, payment due date and amount of late charges and when applied if the patient is make ___ or greater number of payments.
What is 5
What is the name of the form the patient receives from the insurance company.
What is the EOB (Explanation of Benefits)