Chapter 7 : Insurance In The Medical Office.

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Remittance advice
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What does the abbreviation RA stand for ?
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Remittance Advice
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What do primary payers issue to detail how a claim was processed, in order for a secondary claim to be submitted ?
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When the payer handles COB
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When is it not necessary to submit a claim to a secondary payer ?
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Electronic media claims
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What does the abbreviation EMC stand for ?
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Both the CMS-1500 and the RA.
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If a paper RA is received, what should be sent to the secondary health plan ?
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E-Mail
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Which is not a major method of transmitting claims electronically ?
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837P claim
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What is another name for the HIPAA claim ?
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After the claim gets paid or denied.
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When in the billing process is an EOB sent to a patient ?
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Paper claim form
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What is another name for the CMS-1500?
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Clean claim
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A claim accepted by a health plan for adjudication is called ________.
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American Medical Association
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Which association leads the National Uniform Claim Committee (NUCC) ?
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After data elements have been posted to the PMP.
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When are claims prepared for transmission ?
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HIPAA 837
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What is the same as a COB transaction ?
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A message appears on the primary payer's RA.
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What happens when a primary payer forwards the COB transaction ?
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One
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How many national crossover agreements do plans that are supplemental to Medicare sign ?
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EDI
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In the direct claims transmission approach, which formatting rules should the provider follow?
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Extract and record data elements such as diagnoses, procedures, and charges.
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What is a responsibility of medical assistants before transmitting claims with Practice Management Programs ?
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Electronic data interchange
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What does EDI stand for ?
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CMS-1500
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What form should be used to bill a secondary health plan, when a apper RA is received ?
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CMS-1500
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What replaced the HCFA-1500?
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Health information technology.
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What does HIT stand for ?
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When the primary payer handles the COB.
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When does a primary payer not need to submit a claim to the secondary payer ?
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Secondary RA.
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When sending a claim to a tertiary payer, what needs to be attached ?
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Clearinghouses.
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What do the majority of providers use to send and receive data in correct EDI format ?
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Both paper claims and HIPAA claims.
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Which types of claims are generally used for reporting physicians' services ?
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Record diagnoses, procedures, and charges.
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What must a medical assistant do when preparing claims with PMPs?
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NPI.
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What type of information does the Provider section of practice management programs contain ?
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DDE.
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What do some payers offer as an Internet-based service into which employees key the standard data elements ?
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Next of kin.
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What is not a major database in PMPs ?
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Paper form.
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With a few exceptions, the electronic claim is the same as __________.
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Clearinghouse.
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In the direct transmission approach, providers and payers exchange transactions directly without using what ?
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Detailed account of how the claim was processed.
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What is an RA (Remittance advice)?
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HIPAA claim.
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What is considered when the NUCC revises the paper claim ?
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NUCC.
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What organization provides updates the CMS-1500?
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Record patients' insurance and demographic information.
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What is the first task a medical assistant must perform when preparing claims with PMPs ?
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RA.
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What does the administrative/billing medical assistant send in to the secondary payer with the claim form ?
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Hire clearinghouses.
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What is the most common method to handle health care claim transmission ?
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Transactions.
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What are the financial aspects of an office visit, such as copayment, called ?
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Databases.
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What are collections of related facts, such as diagnosis indices, patients of the practice ?
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Practice Management Programs.
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Billing efficiency is increased by using what kind of software?
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Billing provider.
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A _________is the most likely to be sending a claim through a billing service.
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Pay-to-provider.
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A physician practice that uses a billing service to send its claims is the.
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Line item control number.
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On a HIPAA claim, which of these is assigned to a particular service being reported ?
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Both claim control number or line item control number.
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On a HIPAA claim, which of these is assigned to a claim by the sender ?
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National Payer ID.
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Which of these is associated with payers ?
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Rendering provider.
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The provider who performs the procedure on a claim other than the pay-to-provider is called the .
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Rendering provider.
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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?
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All of these.
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Patient information on a CMS-1500 information includes.
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Element.
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A unit of information on a HIPAA claim is called a data.
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Both the HIPAA claim and the 837P claim.
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The HIPAA-mandated electronic transaction for claims is often called the .
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Professional.
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The P in 837P stands for.
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A section on the CMS-1500 for payer name and address.
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The carrier block on the CMS 1500 form is for.
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Insured's information INs.
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On the CMS-1500, if patient and insured are the same person, where is the patient's name and address entered ?
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Both additional form(s) and medical record item(s)
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What type of information might be found on a claim attachment ?
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Billing provider.
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The organization or person transmitting the claim to the payer is the .
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Pay-to-provider.
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The organization or person that should receive payment is the _________.
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Both billing services and clearinghouses.
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Physician practices often hire other firms to send their claims, such as.
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Both the billing provide and the pay-to provider.
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If a practice sends claims directly to the payer, it is the.
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Administrative code sets.
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The taxonomy codes are one of the nonmedical or nonclinical.
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Both the claim control number and the line control number.
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What can be used to track payments from a health plan ?
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Claim filing indictor code.
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What administrative code is used to identify the type of health plan?
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Both claim frequency code and claim submission reason code.
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What code is used to indicate whether a claim is an original, replacement, or voided code ?
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Both the patient's first name and the patient's last name.
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What are examples of data elements ?
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Relatives.
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Which of the following is not one of the five major sections, or levels, of data elements of a claim ?
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Destination payer.
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The part of the HIPAA claim contains information about the payer to whom the claim is going to be sent, called the.
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The medical office.
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A claim control number is assigned by.
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Claim submission reason code.
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The claim frequency code is sometimes known as the.
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Going to be rejected or not.
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The claim frequency code for physician practice claims indicates all of the following except:
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Transactions.
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All of the financial aspects of office visits, such as charges and payments, are.
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National Uniform Claims Committee.
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The abbreviation NUCC stands for.
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CMS-1500 form.
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The NUCC can be expected to continue to update what form ?
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Qualifier.
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A code indicating what a number represents is a.
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Procedures performed for the patient.
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The term service line information describes section 24 of the CMS-1500claim, which reports.
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Outside Laboratory.
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Laboratory services rendered by an independent provider are performed by a (n).
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Location.
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What does a place of service (POS) code describe about a service provided ?
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All of these.
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On the CMS-1500 claim, if the patient and the insured are not the same person, which of these is required ?
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Signature on file.
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The letters "SOF" on a claim mean.
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Ten.
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How many digits are in a taxonomy code?
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Both a current release if applicable and release covers the data on the claim.
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If the claim indicates the patient's signature is on file, this requires.
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Subscriber.
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What term does the HIPAA claim use for the insurance policyholder or guarantor ?
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Individual relationship code.
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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 ?
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Line item control number.
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A unique number assigned by the sender to each service line is a.
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