Terms Chapter 3
The health plan that pays first
What is primary insurance?
Someone who has not received any services from the provider within the past three years
What is a new patient?
Name two of the eight types of charges that may be collected at the time of service.
What is previous balance, co-pay, co-insurance, noncovered or overlimit fees, charges of nonparticipating providers, charges for self-pay, deductibles for CDHP, or charges for copies of medical records?
When is the best time to collect patient information?
The preregistration process
Eligibility for this plan can change monthly
What is Medicaid
What is coordination of benefits (COB)
This insurance pays after the primary insurance has paid.
Established patients have seen the provider within the last __ years
When a patient arrives for an office visit, what document would you use to locate his insurance information?
What is the patient information form?
What medicare form is used to show charges to patients for potentially non-covered services?
What is the ABN? (Advanced beneficiary notice)
This provider meets a patient face-to-face
What is a direct provider?
The primary insurance that pays for a dependent under the gender rule.
Name two of the five types of information collected on new patients
Preregistration and scheduling information
Medical History
Assignment of benefits statement
Insurance data
Acknowledgement of receipt of notice of privacy practices
This is a form completed by the provider that lists diagnoses, procedures, and charges for a patient's visit.
What is an encounter form?
Another name for the HIPAA eligibility for a health plan transaction?
What is X12 270/271
This is a document that a patient signs to guarantee payment when a referral authorization is pending
What is a referral waiver?
If a mother is born May 15, 1984 and the father on October 7, 1983, who is the primary insurance under the birthday rule?
Who is the mother?
For insured patients, what three steps establish financial responsibility?
Verify the patient's eligibility for insurance benefits
Determine preauthorization and referral requirements
determine the primary payer
The name of the response when a health plan asks for approval of a service.
What is the HIPAA referral certification and authorization transaction: X12 278?
A participating physician's agreement to accept allowed charge as payment in full.
What is accept assignment?
These are considered other terms for the encounter form.
The number assigned to a HIPAA 270 electronic transaction
What is a trace number?
This is set up in the practice management program when a patient's chief complain is different than the one for a previous encounter.
What is a new case?
The transaction used to send necessary data to payers for a claim.
What is the HIPAA Coordination of Benefits transaction X12 837?