All
About
That
Insurance
Which of the following...
100
A provider in a contractual relationship with the plan.
What is a participating provider?
100
This part of Medicare pay for inpatient hospital stays and skilled nursing facilities and reimburses hospitals per discharge based on a prospective payment system.
What is A?
100
This is determined from the principal diagnosis and then a higher one is assigned if there are relevant diagnosis of comorbidities or complications.
What is DRG?
100
This begins with the previous month's balance and shows only charges or payments posted in the current period.
What is balance forward?
100
Refers to health insurance policies sold by private insurance companies to fill "gaps" in Medicare plan coverage. Medigap. Medicaid. PPOs. Medicare Part C.
What is Medigap?
200
A portion of each claim is usually the responsibilty of the patient. This might be a flat rate per visit called THIS.
What is a co-pay?
200
This part of Medicare helps patients purchase prescription drugs at a lower cost.
What is D?
200
Posting is done in real time or in THIS.
What is batches?
200
Healthcare professionals use ANSI 837-P, which is equivalent to the paper form of THIS.
What is CMS-1500?
200
Is NOT an unethical and/or illegal practice. Unbundling. Billing for services provided. Billing for levels of service not supported by documentation. Medically unnecessary procedures performed to increase reimbursement.
What is Billing for services provided?
300
Claims are sometimes THIS in the payer's system awaiting further documentation.
What is suspended?
300
Hospitals delay billing for a designated period of time after discharge called this.
What is bill-hold period?
300
The person responsible for the patient's portions of the bill.
What is guarantor?
300
All of the patient's insurance plan have responded with an EOB, any remaining amount owed is the responsibility of THIS.
What is patient?
300
Is a document listing each charge, the amount paid by insurance, the amount written down by the provider, and the amount due from the patient. Patient bill Patient account Open item statement Balance forward patient statement
What is open item statement?
400
Standardized electronic data interchange formats were mandated by..
What is HIPAA?
400
Another name for an encounter form
What is superbill and/or charge ticket?
400
The specific function of converting data arriving in a noncompliant format into a HIPAA-compliant format is performed by THIS.
What is a clearinghouse?
400
Feed charged for using a clearinghouse are paid by...
What is the healthcare facility?
400
Refers to a person who is entitled to receive benefits from a plan.
Who is a beneficiary?
500
Software used to analyze claims for errors before submission.
What is claim scrubber?
500
When asking a plan for further information, supporting documentation, or test results, the claim becomes this.
What is suspended claim?
500
When a patient is covered by more than one insurance, THIS plan adjudicates the claim first, followed by THIS plan.
What is primary; secondary?
500
For every claim that is filed, a provider will receive THIS.
What is an EOB?
500
Is a paper or electronic document that explains the amounts that were paid to the provider. Billing statement Reimbursement statement Patient bill Remittance advice
What is remittance advice?
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