Terms (might not be your definitions) & 1 test question
Test Questions (could be terms)
Potporri
100
To assess how much payment should be made.
What is Review
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 Kitty
What is Ranger
200
The dollar amount a hospital bills out on a case based on the itemized bill
What is Charges
200
The dollar amount a hospital bills an outlier case based on the itemized bill
What is Charges
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
What is so delicate that saying its name breaks it?
What is Silence
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 green and pecks at trees
What is Woody the Wood Pickle...LMAO
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
Claim that that is processed by the ins. carrier but is held in a indeterminate state because of an error or need for more information
What is Suspended Claim
400
A request for a Medicare administrative law judge hearing can be made if the amount in controversy is at least
a. $130.
b. $250.
c. $350.
d. $500.
What is (a) $130.00
400
An insurance claim with an invalid procedure code would be _______________ by the insurance company
What is Rejected
400
What cheese isn't yours?
What is NACHOOOO CHEESEEE....lol
500
If an insured is in disagreement with the insurer for settlement of a claim, a suit must begin within
What is within 3 years
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
Name the five levels of the Medical appeal process