Medical Insurance- Chapter 13 – Flashcards
25 test answers
Unlock all answers in this set
Unlock answers 25question
An insurance aging report lists
answer
Unpaid claims
Unlock the answer
question
Prompt-pay laws govern
answer
insurance carriers' payments of providers' claims
Unlock the answer
question
The payer's RA shows:
answer
both the amount the provider is allowed and the amount patient pays
Unlock the answer
question
RA is the abbreviation for:
answer
remittance advice
Unlock the answer
question
When a payer's RA is received, the medical insurance specialist
answer
checks that the amount paid matches the expected payments
Unlock the answer
question
What does "reconciliation" mean?
answer
to double-check that totals are accurate and consistent
Unlock the answer
question
______________ is a feature of some medical billing programs that automatically records payments in the correct accounts.
answer
Autoposting
Unlock the answer
question
When is an appeal sent to third-party payers?
answer
after a claim is rejected or paid at less than the expected amount
Unlock the answer
question
A medical practice may choose to ____________ a rejected or partially paid claim
answer
either resubmit or appeal
Unlock the answer
question
The abbreviation MRN stands for:
answer
Medicare Redetermination Notice
Unlock the answer
question
What does the abbreviation COB stand for?
answer
Coordination of benefits
Unlock the answer
question
The abbreviation MSP stands for
answer
Medicare Secondary Payer
Unlock the answer
question
A payer's determination means it is going to:
answer
pay, deny, or partially pay the claim
Unlock the answer
question
A payer's automated claim edits may result in claim denial because of
answer
lack of eligibility for a reported service, lack of medical necessity, lack of required preauthorization, any of these
Unlock the answer
question
On an aging report, which category describes a current invoice?
answer
0-30 days
Unlock the answer
question
If a provider has accepted assignment, the payer sends the RA to:
answer
the provider
Unlock the answer
question
Which of these codes might payers use to explain a determination?
answer
claim adjustment group code, claim adjustment reason code, remittance advice remark code, all of these answers are correc
Unlock the answer
question
The advantage(s) of EFT for practices is(are)
answer
funds are available immediately and the transfer is less costly than check deposits.
Unlock the answer
question
The Medicare Secondary Payer program coordinates the benefits for patients who have both Medicare and
answer
any other insurance coverage.
Unlock the answer
question
If a Medicare beneficiary receives treatment for an accident-related claim, the Medicare plan is Multiple Choice
answer
secondary
Unlock the answer
question
If a Medicare beneficiary is covered by a spouse's employer group health plan, the Medicare plan is
answer
secondary
Unlock the answer
