Chpt 7 Insurance Paper Claim CMS-1500 – Flashcards

claim was submitted within the program or policy time limit and contains all necessary information

Insurance claim that has been canceled, deleted, or voided by a Medicare fiscal intermediary for the following reasons: CMS-1500 (08-05) or current CMS-1450 is not used, itemized charges are not provided, more than six line items are submitted on the CMS-1500 (08-05) claim form, patient's address is missing, internal clerical error was made, Certification of Medical Necessity (CMN) was not with the Part B claim or was incomplete or invalid, and name of the store is not on the receipt that includes the price of the item.

A claim submitted with errors or one that requires manual processing to resolve problems or is rejected for payment.

Medicare term for reusable physical supplies such as wheelchairs and hospital beds that are ordered by the provider for use in the home; reported with HPCPS Level II codes.

Claims submitted to the insurance carrier via a central processing unit, tape diskette, direct data entry, direct wire, dial-in telephone, or personal computer via modem

EIN, An individual's federal tax identification number issued by the Internal Revenue Service for income tax purposes

A facility's (hospital, laboratory radiology office, nursing facility) provider number to be used by the facility to bill for services, or by the performing physician to report services done at that location

group NPI, A number assigned to a group of physicians submitting insurance claims under the group name and reporting income under one name.

The CMS-1500 claim form

Any Medicare claim missing necessary information; such claims are identified to the provider so they may be resubmitted

ICR, Same as OCR (opitical character recognition)

Any medical claim that contains complete, necessary information but is illogical or incorrect.

under HIPAA, unique 10-digit identifier assigned to each provider by the National Provider System

the ability to convert images of characters (bitmaps) into computer text that can be stored, searched and edited

medicare claims not considered "clean" claims that require investigation or development on a prepayment basis to determine if Medicare is the primary or secondary carrier.

An insurance claim submitted on paper, including those opticaly scanned and converted to an electronic form by the insurance carrier

An insurance claim held in suspence because of review or other reason.

Insurance claims with no staples or highlighted areas. The bar code areas has not been deformed.

A claim that is returned to the hospital by the payer because the claim contained a technical error or could not be processed because it was completed in accordance with payer guidelines.

an individual's tax identification number issued by the federal government.

The physician must obtain this number in order to practice within a state.