Billing
Terminology
Medicare
Denials
Prime Suite
100
The 3 types of Global periods.
What are 0, 10 and 90 days?
100
An ICN# is?
What is an Internal Control Number (aka: Insurance Claim Number)?
100
A private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.
What is a MAC? (Medicare Administrative Contractor)
100
PTP edits through NCCI gives us guidelines on what denial?
Bundling
100
I need to correct the mailing address for an insurance company's plan. I go here in Prime Suite to update this info.
What is the Insurance Plans page?
200
What are:
PR1
PR2
PR3
Patient Responsibility Deductible
Patient Responsibility Co-Insurance
Patient Responsibility Co-pay
200
CO-253: Mandatory payment reductions in the Medicare FFS program.
What is Sequestration?
200
Federal Health Insurance program for Railroad Retirees and their dependents.
What Railroad Medicare?
200
This provides additional explanation for an adjustment code already described on an EOB.
What is RARC? Remittance Advice remark Code
200
I don't understand the Account Information page in Prime Suite. Where do I go in Prime Suite for help?
What is the question mark? The Prime Suite Learning Center.
300
Diagnostic testing helps health care providers screen for or monitor specific diseases or conditions. If the provider has a Lab in their office, it must have a certification called what?
What is a CLIA#? (Clinical Laboratory Improvement Amendments)
300
The sum (the "pay up to" amount) an insurance company will reimburse to cover a healthcare service or procedure.
What is Allowed Amount?
300
A patient may sign this BEFORE a procedure/service that states they accept financial responsibility if Medicare does not pay.
What is an ABN? (Advanced Beneficiary Notice)
300
I had surgery last week. I got a letter in the mail from my insurance stating that my provider forgot to get an ______________: A decision by the health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary.
What is an authorization? (or pre-certification or pre-authorization)
300
Page in Prime Suite where you can add a note in BOX 19 on a claim form.
What is the Group Information page?
400
I to need make a simple claims correction on a paid, closed claim. I call the insurance company and request a____________.
What is a Re-opening?
400
The unique ID # assigned to an insurance company for the purpose of transmitting claims electronically.
What is Payer ID#? (or EDI#)
400
When I am checking to see what is Medicare's defined max # of units I can bill on a specific CPT code billed, what am I reviewing?
What is MUE? (Medically Unlikely Edits)
400
Medicaid is telling me that they paid 0 with no denials on a claim. On the EOB it has the CARC: OA-23. What does this mean?
The primary has paid more than the secondary allows. This is a Medicaid adjustment.
400
I corrected and resent an electronic claim. Where did it go first?
What is Claims Processing?
500
I corrected a BCBS primary commercial claim. I want to resubmit it electronically. What 2 things MUST be included when re-sending the claim? And if I decide to mail the claim instead, where do I go (the last step) in Prime Suite to print the claim?
What are Frequency 7 and the Original Claim #?
What is the Claims Status page?
500
This is the provider’s unique number assigned by Medicare that we have to have to use the IVR and speak with Medicare representatives.
What is Provider Transaction Access Number (PTAN)?
500
I just turned 65 years old three months ago. I am having my annual exam done tomorrow. What is the name of the Medicare service my provider will bill for this annual exam?
What is IPPE (Initial Preventative Physical Examination) or "Welcome To Medicare Preventative Visit"?
500
My Medicare MAC denied CPT 11042 for the diagnosis does not meeting medical necessity. Where do I go on the CMS website to find out why?
What are the LCD policies?
500
I need to find a paper check (EOB) that was posted into Prime Suite. Where do I go to locate the BOX file information (batch# & name) on the payment?
What is Account Information?