question

Once the List Only... filters have been applied, only the claims that match the criteria are listed at the__________of the main Claim Management dialog box.

answer

bottom

question

The insurance claim is the most important document for ______.

answer

correct reimbursement from payers

question

In Medisoft Network Professional, the date that a claim was created is entered in ____________ format.

answer

MMDDCCYY

question

In Medisoft Network Professional, an attachment control number is required if the transmission code is __________.

answer

Other than AA

question

In Medisoft Network Professional, the __________provider is the patient's regular physician.

answer

assigned

question

A(n)________________review checks for bundled codes, among other things.

answer

automated

question

A filter is defined as a condition that data must meet to be

answer

selected

question

_________________is a method of claim transmission in which a member of the provider's billing staff manually enters claims into an application on the payer's website.

answer

Direct data entry (DDE)

question

The "official" name for the HIPAA standard transaction for electronic claims is the

answer

HIPAA X12 837 Health Care Claim

question

____________ provide further detail for claim status category codes.

answer

claim status codes

question

When a claim is active in Medisoft Network Professional's Claim Management dialog box, it can be edited by

answer

clicking the Edit button double-clicking on the claim itself

question

Multiple indicators in the Case Indicator box of Medisoft Network Professional's Create Claims dialog box must be separated by __________.

answer

commas

question

During the payer's adjudication process, if the automated review finds problems, the claim is ____________ and set aside for development.

answer

suspended

question

A claims examiner contacts the office regarding the place of service for a particular claim. The claim is likely to be in the _____________ step of the adjudication process.

answer

manual review

question

Insurance claims are ____________ for payment within the Claim Management area of Medisoft Network Professional.

answer

created edited submitted

question

Before claims are sent, Medisoft Network Professional performs edits, including

answer

ANSI edits user-defined edits common edits

question

The HIPAA claim can capture over ______data elements.

answer

1,000

question

The Last Claim button in Medisoft Network Professional's Claim Management dialog box

answer

makes the last claim in the list active

question

A printout of a paper claim is easy to read; a printout of a HIPAA claim___________.

answer

cannot easily be read because it prints out in a computer format that removes blank spaces

question

If a particular payer states in the participation contract that it will pay claims on the twenty-fifth day, for what date would the biller set the PM/EHR to automatically issue a HIPAA 276 for unpaid claims?

answer

the twenty-sixth day, the first date that the payment is overdue

question

To run the various edits that are possible in Medisoft Network Professional before transmitting electronic claims, click ________________after selecting Claims on the Process menu.

answer

Check Claims

question

The ________________________ of the payer checks for medical necessity.

answer

medical review program

question

In Medisoft Network Professional, a report ________code is a two-digit code that indicates how a report is being sent to the ________.

answer

transmission; payer

question

________________buttonssimplify the task of moving from one entry to another.

answer

Navigator

question

To transmit electronic claims, the practice must establish _______with clearinghouses and payers.

answer

accounts

question

The ____________ tab(s) in Medisoft Network Professional's Claim dialog box display(s) information about claims being submitted to a patient's non primary insurance carriers.

answer

Carrier 1 and Carrier 2

question

Medisoft Network Professional claims can be selected and viewed by

answer

insurance carrier batch number chart number

question

What boxes are located in the EDI Report section in Medisoft Network Professional?

answer

Report Type Code Attachment Control Number Report Transmission Code

question

The time period in which a health plan is obligated to process a claim

answer

claim turnaround time

question

Claims that are billed to Medicare and then submitted to Medicaid

answer

crossover claims

question

The process followed by health plans to examine claims and determine benefits

answer

adjudication

question

A condition that data must meet to be selected

answer

filter

question

The rules that specify the number of days after the date of service that the practice has to file the claim

answer

timely filing

question

A payer's decision about the benefits due for a claim

answer

determination

question

Claim status during adjudication when the payer is waiting for information from the submitter

answer

pending

question

The smallest units of information in a HIPAA transaction, such as a person's name

answer

data elements

question

Classification of accounts receivable by the length of time an account is due

answer

aging

question

The term is used by payers to indicate that more information is needed for claim

answer

development

question

(T/F) In Medisoft Network Professional, filters are applied in the Claim Management dialog box.

answer

False - filters are applied in the List Only Claims That Match dialog box

question

(T/F) When an attachment must accompany a claim filed electronically, specific information must be entered in the Diagnosis tab of the Case folder in Medisoft Network Professional.

answer

True

question

(T/F) Insurance claims are created from within the Revenue Management area of Medisoft Network Professional.

answer

False - they are created within the Claim Management area

question

(T/F) For each service line on a claim, the payer makes a payment adjudication—a decision whether to (1) pay it, (2) deny it, (3) hold it for further processing, or (4) pay it at a reduced level.

answer

False - the payer makes a payment determination

question

(T/F) The HIPAA X12 276/277 Health Care Claim Status Inquiry/ Response is the standard electronic transaction to obtain the current status of a claim during the adjudication process.

answer

True

question

(T/F) The HIPAA standard transaction for electronic claims is the HIPAA X12 837 Health Care Claim, usually called the HIPAA claim.

answer

True

question

(T/F) The HIPAA 277 transaction from the payer uses claim status category codes for the main types of responses.

answer

True

question

(T/F) A claim that has a yellow flag in the Edit Status column in Revenue Management must be corrected before it can be sent to a payer or clearinghouse.

answer

False - a yellow flag is not serious enough to prevent the claim from being sent, but indicates an increased possibility it will be rejected by the payer

question

(T/F) A medical necessity denial may result from lack of a clear, correct linkage between the diagnosis and procedure.

answer

True

question

(T/F) Claims billed to Medicare and then submitted to Medicaid are called coordinated claims.

answer

False - they are called crossover claims

question

The HIPAA standard transaction for paper claims is known as the ________________.

answer

CMS-1500 (08/05) Claim

question

The upper-right corner of the Claim Management dialog box contains five ______________ that simplify the task of moving from one entry to another.

answer

navigator buttons

question

A ________________ is a condition that data must meet to be selected.

answer

filter

question

The _____________ method of submitting electronic claims requires manual entry of data on the payer's website.

answer

direct data entry

question

Medisoft Network Professional's __________________ feature allows claims to be reviewed and edited before they are submitted to insurance carriers for payment.

answer

Claim Edit

question

To perform an edit check on claims in Revenue Management, click _________________ to select the EDI receiver.

answer

Check Claims

question

Claims billed to Medicare and then submitted to Medicaid are called __________________.

answer

crossover claims

question

Each claim undergoes a checking process known as _______________ , made up of these steps the health plan follows to judge how it should be paid.

answer

adjudication

question

A _______________ may result from lack of a clear, correct linkage between the diagnosis and procedure.

answer

medical necessity denial

question

The ___________________ is the standard electronic transaction to obtain the current status of a claim during the adjudication process.

answer

HIPAA X12 276/277 Health Care Claim Status Inquiry/Response

question

NUCC

answer

National Uniform Claim Committee

question

HIPAA X12 276/277

answer

HIPAA Health Care Claim Status Inquiry/Response

question

HIPAA X12 837

answer

HIPAA Health Care Claim

MED 134 ch 10 – Flashcards

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