dsh chap 10 & 11 true/false ehr – Flashcards
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in medisoft network professional, filters are applied in the claim management dialog box
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list only claims that match dialog box
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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
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insurance claims are created from within the revenue management area of the medisoft network professional
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claim management area
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for each service line on a claim, the payer makes payment adjudication - decision whether to (1) pay it, (2) deny it, (3) hold it for further processing, or (4) pay it at a reduced level
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the hipaa x 12 276/277 health care claim status inquiry response is the standard electronic transaction to obtain the current status of a claim during the adjudication process
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the hipaa standard transaction for electronic claims is the hipaa x12 837 health claim care claim, usually called the hipaa claim
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the hipaa 227 transaction from the payer uses claim status category codes for the main types of repsonses
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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
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a medical necessity denial may result from lack of a clear, correct linkage between the diagnosis and procedure
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claims billed to medicare and then submitted to medicaid are called coordinated claims
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crossover claims
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an appeal is a process that can be used to challenge a payer's decision to deny, reduce, or otherwise downcode a claim
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capitation payments are made to physicians on a regular basis
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standard statements list only those charges that are not paid in full after all insurance carrier payments have been received
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remainder statements
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capitation payments are entered in the claim management dialog box
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are entered in the deposit list dialog box
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ra's (remittance advice) cover group of claims, not just a single claim
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in cycle billing, all statements are printed and mailed at once
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patients are divided into groups, and statements printing and mailing is staggered throughout the month
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the purpose of an RAC (recovery audit contractor) is to audit medicare claims and determine where there are opportunities to recover incorrect payments from previously paid but non-covered services, erroneous coding, and duplicate services
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eft (electronic funds transfer) occurs when the payer sends a check to the practice, and the check is taken to the practice's bank for deposit
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true
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a non-sufficient funds (NSF) check is also commonly called a "bounced" or a "returned" check
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true
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to apply a deposit in MNP, the payment is highlighted in the deposit list dialog box, and the apply button is clicked
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true
