question

Remittance advice

answer

What does the abbreviation RA stand for ?

question

Remittance Advice

answer

What do primary payers issue to detail how a claim was processed, in order for a secondary claim to be submitted ?

question

When the payer handles COB

answer

When is it not necessary to submit a claim to a secondary payer ?

question

Electronic media claims

answer

What does the abbreviation EMC stand for ?

question

Both the CMS-1500 and the RA.

answer

If a paper RA is received, what should be sent to the secondary health plan ?

question

E-Mail

answer

Which is not a major method of transmitting claims electronically ?

question

837P claim

answer

What is another name for the HIPAA claim ?

question

After the claim gets paid or denied.

answer

When in the billing process is an EOB sent to a patient ?

question

Paper claim form

answer

What is another name for the CMS-1500?

question

Clean claim

answer

A claim accepted by a health plan for adjudication is called ________.

question

American Medical Association

answer

Which association leads the National Uniform Claim Committee (NUCC) ?

question

After data elements have been posted to the PMP.

answer

When are claims prepared for transmission ?

question

HIPAA 837

answer

What is the same as a COB transaction ?

question

A message appears on the primary payer's RA.

answer

What happens when a primary payer forwards the COB transaction ?

question

One

answer

How many national crossover agreements do plans that are supplemental to Medicare sign ?

question

EDI

answer

In the direct claims transmission approach, which formatting rules should the provider follow?

question

Extract and record data elements such as diagnoses, procedures, and charges.

answer

What is a responsibility of medical assistants before transmitting claims with Practice Management Programs ?

question

Electronic data interchange

answer

What does EDI stand for ?

question

CMS-1500

answer

What form should be used to bill a secondary health plan, when a apper RA is received ?

question

CMS-1500

answer

What replaced the HCFA-1500?

question

Health information technology.

answer

What does HIT stand for ?

question

When the primary payer handles the COB.

answer

When does a primary payer not need to submit a claim to the secondary payer ?

question

Secondary RA.

answer

When sending a claim to a tertiary payer, what needs to be attached ?

question

Clearinghouses.

answer

What do the majority of providers use to send and receive data in correct EDI format ?

question

Both paper claims and HIPAA claims.

answer

Which types of claims are generally used for reporting physicians' services ?

question

Record diagnoses, procedures, and charges.

answer

What must a medical assistant do when preparing claims with PMPs?

question

NPI.

answer

What type of information does the Provider section of practice management programs contain ?

question

DDE.

answer

What do some payers offer as an Internet-based service into which employees key the standard data elements ?

question

Next of kin.

answer

What is not a major database in PMPs ?

question

Paper form.

answer

With a few exceptions, the electronic claim is the same as __________.

question

Clearinghouse.

answer

In the direct transmission approach, providers and payers exchange transactions directly without using what ?

question

Detailed account of how the claim was processed.

answer

What is an RA (Remittance advice)?

question

HIPAA claim.

answer

What is considered when the NUCC revises the paper claim ?

question

NUCC.

answer

What organization provides updates the CMS-1500?

question

Record patients' insurance and demographic information.

answer

What is the first task a medical assistant must perform when preparing claims with PMPs ?

question

RA.

answer

What does the administrative/billing medical assistant send in to the secondary payer with the claim form ?

question

Hire clearinghouses.

answer

What is the most common method to handle health care claim transmission ?

question

Transactions.

answer

What are the financial aspects of an office visit, such as copayment, called ?

question

Databases.

answer

What are collections of related facts, such as diagnosis indices, patients of the practice ?

question

Practice Management Programs.

answer

Billing efficiency is increased by using what kind of software?

question

Billing provider.

answer

A _________is the most likely to be sending a claim through a billing service.

question

Pay-to-provider.

answer

A physician practice that uses a billing service to send its claims is the.

question

Line item control number.

answer

On a HIPAA claim, which of these is assigned to a particular service being reported ?

question

Both claim control number or line item control number.

answer

On a HIPAA claim, which of these is assigned to a claim by the sender ?

question

National Payer ID.

answer

Which of these is associated with payers ?

question

Rendering provider.

answer

The provider who performs the procedure on a claim other than the pay-to-provider is called the .

question

Rendering provider.

answer

Assume that three providers are indicated on a claim for lab services.A clearinghouse is the billing provider and the physician practice is the pay-to-provider. What type of provider is the laboratory?

question

All of these.

answer

Patient information on a CMS-1500 information includes.

question

Element.

answer

A unit of information on a HIPAA claim is called a data.

question

Both the HIPAA claim and the 837P claim.

answer

The HIPAA-mandated electronic transaction for claims is often called the .

question

Professional.

answer

The P in 837P stands for.

question

A section on the CMS-1500 for payer name and address.

answer

The carrier block on the CMS 1500 form is for.

question

Insured's information INs.

answer

On the CMS-1500, if patient and insured are the same person, where is the patient's name and address entered ?

question

Both additional form(s) and medical record item(s)

answer

What type of information might be found on a claim attachment ?

question

Billing provider.

answer

The organization or person transmitting the claim to the payer is the .

question

Pay-to-provider.

answer

The organization or person that should receive payment is the _________.

question

Both billing services and clearinghouses.

answer

Physician practices often hire other firms to send their claims, such as.

question

Both the billing provide and the pay-to provider.

answer

If a practice sends claims directly to the payer, it is the.

question

Administrative code sets.

answer

The taxonomy codes are one of the nonmedical or nonclinical.

question

Both the claim control number and the line control number.

answer

What can be used to track payments from a health plan ?

question

Claim filing indictor code.

answer

What administrative code is used to identify the type of health plan?

question

Both claim frequency code and claim submission reason code.

answer

What code is used to indicate whether a claim is an original, replacement, or voided code ?

question

Both the patient's first name and the patient's last name.

answer

What are examples of data elements ?

question

Relatives.

answer

Which of the following is not one of the five major sections, or levels, of data elements of a claim ?

question

Destination payer.

answer

The part of the HIPAA claim contains information about the payer to whom the claim is going to be sent, called the.

question

The medical office.

answer

A claim control number is assigned by.

question

Claim submission reason code.

answer

The claim frequency code is sometimes known as the.

question

Going to be rejected or not.

answer

The claim frequency code for physician practice claims indicates all of the following except:

question

Transactions.

answer

All of the financial aspects of office visits, such as charges and payments, are.

question

National Uniform Claims Committee.

answer

The abbreviation NUCC stands for.

question

CMS-1500 form.

answer

The NUCC can be expected to continue to update what form ?

question

Qualifier.

answer

A code indicating what a number represents is a.

question

Procedures performed for the patient.

answer

The term service line information describes section 24 of the CMS-1500claim, which reports.

question

Outside Laboratory.

answer

Laboratory services rendered by an independent provider are performed by a (n).

question

Location.

answer

What does a place of service (POS) code describe about a service provided ?

question

All of these.

answer

On the CMS-1500 claim, if the patient and the insured are not the same person, which of these is required ?

question

Signature on file.

answer

The letters "SOF" on a claim mean.

question

Ten.

answer

How many digits are in a taxonomy code?

question

Both a current release if applicable and release covers the data on the claim.

answer

If the claim indicates the patient's signature is on file, this requires.

question

Subscriber.

answer

What term does the HIPAA claim use for the insurance policyholder or guarantor ?

question

Individual relationship code.

answer

On the HIPAA claim, what code is required to specify the patient's relationship to the subscriber when the patient and the subscriber are not the same person ?

question

Line item control number.

answer

A unique number assigned by the sender to each service line is a.

Chapter 7 : Insurance In The Medical Office.

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