question

Payment plans can be negotiated between

answer

Payer or provider or Patient or provider

question

When does Medical necessity denial occur?

answer

Elective surgery

question

What is a detention schedule?

answer

How long medical records should be held by a practice.

question

What is in a Charge Master?

answer

Services, Codes and Charges

question

Nest step in payment for automated review is

answer

Manual review

question

What is a comorbidity?

answer

Coexisting condition

question

What does a skip trace do?

answer

Locates patients with outstanding balances.

question

What does a grouper do? Software use to help to assign DRGs

answer

Software use to help to assign DRGs

question

When a payer rejects a claim what are the medical practices options?

answer

Resubmit the 837 file.

question

After a claim has been process the payer sends what to the patient?

answer

RA/EOB - Remitted Advice/EOB

question

A payer's initial claim review may reject the claim do to which of the following.

answer

Invalid policy number

question

Software in office catches errors before submitting

answer

Scrubber

question

A practices retention schedule protects who?

answer

Provider and patient

question

What's the usual classification for an age report?

answer

30, 60 90

question

After an account has been determined to be uncollectable, it is removed from A/R, its called.

answer

Bad Debt, write off,

question

ASU

answer

Ambulatory surgical Unit

question

ASC Ambulatory surgical Clinic

answer

Ambulatory surgical Clinic

question

Which insurance company requires a POA indicator? (Present on Admission)

answer

Medicare

question

Claim adjustment reason codes are used by who on what?

answer

Payer, uses them; Printed on EOB or RAs. Provide more details on payment

question

ICD-9 Volume 1 and 2 has.

answer

3-5 digits

question

What is the format of the ICD-9-CM Volume 3 codes?

answer

3-4 digits

question

DRG

answer

Diagnosis Related Group

question

In order to have good effect patient billing we must have?

answer

Sound financial policy

question

For most patients, their first notice that their bill is past due is?

answer

Collection letter

question

HHA

answer

Home Health Agency

question

HIM

answer

Health Information Management

question

If a Medicare beneficiary is covered by a spouse's employer group health plan the Medicare plan is primary or secondary?

answer

Secondary

question

If a Medicare beneficiary is employed and covered by their employers group health plan, Medicare is.

answer

Secondary

question

If a Medicare beneficiary receives treatment for an accident related claim the Medicare plan is.

answer

Secondary

question

If a provider has accepted assignment the payers sends the RA or EOB to the provider the patient the billing services or carrier?

answer

Provider

question

If provider has not accepted assignment the payer will send the payment to?

answer

Patient

question

In cycle billing, the practice mails statements how often?

answer

All throughout the month.

question

The process of admitting an inpatient to the hospital is called?

answer

Registration

question

MSDRG definition

answer

Medicare Severity Diagnosis-Related Group

question

MSDRG

answer

Medicare Inpatient Prospective Payment System revision that takes into account whether certain conditions were present on admission.

question

OPPS

answer

Outpatient Prospective Payment System

question

IPPS

answer

Inpatient Prospective Payment System

question

Who uses OPPS and IPPS?

answer

Medicare Part B

question

Patients are grouped under the insurance policy holder in what type of billing?

answer

Guarantor

question

Patient are listed in a patient register under a unique number which makes up the

answer

Master Patient Index

question

SNF

answer

Skilled Nursing Facility

question

MSP Rules

answer

Medicare Secondary Payer

question

The clinician is primarily responsible for the care of the patient from the beginning of a hospital episode is?

answer

Attending physician

question

_________are total transaction that were posted to all patient ledgers on a particular business day.

answer

Day sheets

question

FACTA?

answer

Fair and Accurate Credit Transaction Act

question

FCRA

answer

Fair Credit Reporting Act

question

FDCPA

answer

Fair Debt Collection Practices Act

question

What does the Truth and Lending Act require? Let a creditor know about finance rate, late fees, etc..

answer

Let a creditor know about finance rate, late fees, etc..

question

What are the three big steps in hospital claim processing?

answer

Admissions, Record of treatment and Discharge and billing

question

The job of working directly with the practice's patients to resolve payment problems is done by:

answer

The collections specialist

question

The law that required consumer reporting agencies to have reasonable and fair procedures is:

answer

FCRA

question

The type of patient billing that spreads out the workload of mailing statements is:

answer

Cycle billing

question

The first step in the Medicare appeals process is:

answer

Redetermination

question

If a Medicare beneficiary is covered by a spouse's employer group health plan, the Medicare plan is: Secondary.

answer

Secondary

question

If a Medicare beneficiary receives treatment covered by workers' compensation, the Medicare plan is:

answer

Secondary

question

When the hospital staff collects data on a patient who is being admitted for services, the process is called

answer

Registration

question

Inpatient coding, the initials CC mean

answer

Comorbidities and complications

question

Diagnosis-related groups (DRGs)

answer

A system of analyzing conditions and treatments for similar groups of patients used to establish Medicare fees for hospital inpatient services

question

Attending physician

answer

The clinician primarily responsible for the care of the patient from the beginning of the hospital episode

question

Principal diagnosis

answer

The patient's condition identified by the physician at admission to the hospital

question

837I

answer

HIPAA standard transaction for the facility claim

question

Principal procedure

answer

The main service performed for the condition listed as the principal diagnosis for a hospital inpatient

question

Admitting diagnosis

answer

The patient's condition identified by the physician at admission to the hospital

question

Charge master

answer

A hospital's list of the codes and charges for its services

question

Ambulatory care

answer

Outpatient care

question

Comorbidities

answer

Conditions in addition to the principal diagnosis that the patient had at hospital admission which affect the length of the hospital stay or the course of treatment

question

Inpatient

answer

A person admitted to a hospital for services that require an overnight stay

question

Under Medicare rules for patients in car accidents, the automobile insurance is

answer

Primary

question

Which of the following hospital departments has different procedures for collecting patients' personal and insurance information?

answer

Emergency department

question

Under a Prospective Payment System, payments for services are

answer

Set in advance

question

Conditions that arise during the patient's hospital stay as a result of surgery or treatments are called

answer

Complications

question

The code 76.23 is an example of which type of code?

answer

ICD-9-CM Volume 3

question

Patient charges in hospitals vary according to

answer

Their accommodations and services

question

Which of these rules governs the reporting of hospital inpatient services on insurance claims?

answer

UHDDS

question

The clinician primarily responsible for the care of the patient from the beginning of the hospital episode is called the:

answer

Attending physician

question

What type of facility is equipped for patients to stay overnight?

answer

Inpatient

question

What involves a situation in which a delay in treatment would lead to a significant increase in the threat to a patient's life or body part?

answer

Emergency care

question

Which term describes the main service performed for the condition listed as the principal diagnosis for a hospital inpatient?

answer

Principal procedure

question

Which term describes the patient's condition upon hospital admission?

answer

Admitting diagnosis

question

Each MDC is subdivided into ____________ MS-DRGs.

answer

Medical and surgical

INSURANCE BILLING EXAM CHP 14,15 AND 18 – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards