A single charge for a day in the hospital regardless of any actual charges.
What is Per Diem
100
A report which is run that indicates which claims are outstanding.
What is Aging Reports
100
Health Maintenance Organization
What is HMO
100
This is done after the appeals process
What is a Peer Review
100
What is the name of Ms. Macke's husband
What is Paul
200
The dollar amount a hospital bills out on a case based on the itemized bill
What is Charges
200
Claim that is held in a pending state because of an error or need for more information.
What is Suspended Claim
200
Insurance claim that cannot be found
What is Lost Claim
200
This protects the insurance industry with special exemptions
What is FTC (FEDERAL TRADE COMMISSION)
200
18 (blackish greyish)
What is the number of chairs in our lecture room.
300
Money paid over and above the amount the amount due by the insurance or patient.
What is Overpayment
300
A patient who receives services in a health care facility, such as a physician’s office, clinic, urgent care center, ER or ambulatory surgical center and goes home the same day.
What is Outpatient
300
A term used when a patient is admitted to the hospital for an overnight stay.
What is Inpatient
300
If you have a payment problem with an insurance company this is who you report it to
What is State Insurance Commissioner.
300
What is so delicate that saying its name breaks it?
What is Silence
400
The process in which computer software checks for errors before a claim is submitted to an insurance carrier for payment.
What is Scrubbing
400
Insurance claim submitted to an insurance company and payment is overdue.
What is Deliquent Claim
400
A claim that is discarded by the insurance company because of a technical error
What is a Rejected Claim
400
An insurance claim with an invalid procedure code would be _______________ by the insurance company
What is Rejected
400
Dolphins
What is Ms. Macke's favorite fish.
500
A system of payment used by managed care plans in which physicians and hospitals are paid a fixed per capita amount for each patient enrolled over a stated period of time, regardless of the type and number of services provided.
What is Capitation
500
Request for review of an insurance claim that has been underpaid or denied by ins. company to receive additional payment.
What is Appeal
500
Latin Translation: By the Day
What is Per Diem
500
The first level of appeal in the Medicare Program is
What is Redetermination.
500
What occurs once in a minute, twice in a moment and never in one thousand years?