MEDA 221 Test 13 – Flashcards
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Medicare Secondary Payer
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MSP
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This explains Medicare's unfavorable response to a request for redetermination
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Medicare Redetermination Notice
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How many steps are there in the Medicare appeal process?
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5
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to double-check that totals are accurate and consistent
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reconciliation
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The _____________ of a claim refers to the payer's decision regarding payment.
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determination
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A medical practice may choose to ____________ a rejected or partially paid claim.
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appeal or resubmit
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A paper explanation of benefits (EOB) is sent to patients by payers after claims:
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are paid
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______________ follow up on claims that are not processed within the specified claim turnaround time for the payer.
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medical insurance specialists
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An aging report groups unpaid claims or bills according to:
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the length of time they remain due
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The payer's processing of claims is called
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adjudication
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An ___ code indicates that a request for more information has been sent
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R
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the date of claim transmission and receipt of payment
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claim turnaround time
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If a provider has accepted assignment, the payer sends the RA to:
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the provider
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If a patient has additional insurance coverage, after the primary payer's RA has been posted, the next step is:
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billing the second payer
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Minor errors found on transmitted claims can usually be corrected by asking the payer to reopen the claim and make the changes.
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true
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This shows both the amount the provider is allowed and the amount patient pays
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payer's RA
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what code indicates an error has occurred in transmission?
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E
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insurance carriers' payments of providers' claims are governed by
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prompt-pay laws
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what is done by a payer to determine the appropriateness of medical services
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utilization review
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A claim that is removed from a payer's automated processing system is sent for
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manual review
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Which of these HIPAA transactions is sent by a payer to explain a claim payment?
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835
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A payer's determination means it is going to:
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pay, deny, or partially pay the claim
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If a medical practice believes that it has been treated unfairly by an insurance company, it has the right to file a ____________ with the state insurance commission.
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grievance
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If Medicare is the secondary payer, the claim must be submitted using the
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HIPAA 837
