Question

aTransminter ID h Claims clearinghouse e Downcoding d Esplanation of benefits (O e National Provider ldenni Section 2 10. o Aa imomediary thue aees the elecmoms ctaim from the provider plan, and subuts clai 1 Aa defier assigsod by te Crs for Medicare and Medicaid license and NPIs) f Remark code g Medical necessity h. Dirty claims i Copayme under which the claim was paid or desiod 13 Found os the putiens's health nsurance ID card and in needed dentity the specilic health pln so which the claim should be uhmited 14 pewwakr suy be inclined so coule to a higher specificity level thon the service povidod actually involved k Intentional L Upoding m Deductible 15 Clainms with incorrect, missing, or imufficicn data 16. A form that is sens by the insurance compuny to the provider who document indicating that funds were electrosically transferred ustenitsed the serce claim wih an accompanying check or a 17 Insurance camier's decision id the tests and treatments indicated by the CPT and HCPCS codes nees the accepsied standard of practice to treat the patient's diagmosis indicated by the SCD code. K A patit financial sesponsihlity that the sabscriber for the policy is contracted per year se pay towasd his or her healthcare before the nsurance policy seimburses the providar 19 When a kwer specificity level or mone gescralined code, is assigsod 20 A policy provisicn in which the policyboider and the insurance company shase the cost of coverod molical services in a specilicd 2I A patien finncial nesposubility thut is dee at the time of the office 22 Desrnining whether trasdulen medical hilling peactices wese done with parpose r by accides SKILLS AND CONCEPTS Part t Short Answer Questions I List four types of inforution collected when a patiens calls to schedule an appointment Onte tt

Answer 1

10. Intermediary that accepts the electronic claim from the provider, re-formats the claim to the specifications outlined by the insurance plan, and submits the claims ________________________

Option"b" Claims Clearinghouse

11.An identifier assigned by the Centers for Medicare and Medicaid Services that classifies the healthcare provider by license and medical specialties ______________________

Option "e" National Provider Identifiers (NPIs)

12. On the EOB where the payer indicates the conditions under which the claim was paid or denied ___________________

Option "f" Remark Codes

13. Found on the patient's health insurance ID card and is needed to identify the specific health plan to which the claim should be submitted _____________

Option "a" Transmitter ID

14.When the provider may be inclined to code to a higher specificity level than the service provided actually involved ____________________

Option "l" Upcoding

15.Claims with incorrect, missing, or insufficient data _____________

option"h" Dirty claims

16.A form that is sent by the insurance company to the provider who submitted the insurance claim, which accompanies a check or a document indicating that funds were electronically transferred _________

Option"d" Explanation of Benefits (EOB)

17. Insurance carrier's decision if the tests and treatments indicated by the CPT and HCPCS codes meet the accepted standard of practice to treat the patient's diagnosis indicated by the ICD code __________

Option"g" Medical Necessity

18.A patient financial responsibility that the subscriber for the policy is contracted per year to pay toward their healthcare before the insurance policy reimburses the provider ______________

Option"m" Deductible

19.When a lower specificity level, or more generalized code, is assigned _______________

Option"c" Downcoding

20. A policy provisions in which the policyholder and the insurance company share the cost of covered medical services in a specified ratio _________________

Option "j" Coinsurance

21.A patient financial responsibility, which is due at the time of the office visit ______________

Option "i" Copayment

22. Determining whether fraudulent medical billing practices were done with purpose or by accident ___________

Option "k" Intentional

Part I: Short answer questions

1. List four types of information collected when a patient calls to schedule an appointment

a.information about the insured
b. information about the employer
c. demographic information
d. health insurance data