Podcast
Questions and Answers
What does NPI stand for, and what purpose does it serve in healthcare?
What does NPI stand for, and what purpose does it serve in healthcare?
National Provider Identifier. It's a unique identifier for healthcare providers required by HIPAA.
Explain the significance of a 'policy number' in the context of health insurance.
Explain the significance of a 'policy number' in the context of health insurance.
It identifies the contract between the insurance company and the policyholder.
Differentiate between an 'in-network' and an 'out-of-network' provider. What are the potential financial implications of choosing an out-of-network provider?
Differentiate between an 'in-network' and an 'out-of-network' provider. What are the potential financial implications of choosing an out-of-network provider?
In-network providers have contracts with the insurance company, usually resulting in lower costs for the patient. Out-of-network providers do not, potentially leading to higher out-of-pocket expenses.
Define 'non-covered charges' in health insurance, and give a possible reason they arise.
Define 'non-covered charges' in health insurance, and give a possible reason they arise.
What is the 'timely filing limit,' and why is it important for healthcare providers to adhere to it?
What is the 'timely filing limit,' and why is it important for healthcare providers to adhere to it?
Explain the purpose of the 'UB-92/UB-04/CMS 1450' form in healthcare billing.
Explain the purpose of the 'UB-92/UB-04/CMS 1450' form in healthcare billing.
Describe what a 'write-off' is in the context of medical billing, and who typically bears the cost of a write-off?
Describe what a 'write-off' is in the context of medical billing, and who typically bears the cost of a write-off?
What is the purpose of a 'W-9 form', and what information does it verify?
What is the purpose of a 'W-9 form', and what information does it verify?
In what scenario is an NPI number for healthcare providers most critical based on the information provided in the text?
In what scenario is an NPI number for healthcare providers most critical based on the information provided in the text?
If a service is considered a 'non-covered charge,' what are the potential financial consequences for the patient?
If a service is considered a 'non-covered charge,' what are the potential financial consequences for the patient?
Explain how the 'policy number' is utilized in the healthcare revenue cycle.
Explain how the 'policy number' is utilized in the healthcare revenue cycle.
What steps can a patient take to minimize the risk of receiving 'out-of-network' care unintentionally?
What steps can a patient take to minimize the risk of receiving 'out-of-network' care unintentionally?
Describe the relationship between a 'participating provider' and an insurance company.
Describe the relationship between a 'participating provider' and an insurance company.
Why is it important for healthcare providers to maintain accurate records of 'timely filing limits' for different payers?
Why is it important for healthcare providers to maintain accurate records of 'timely filing limits' for different payers?
What type of healthcare facilities primarily use 'UB-92/UB-04/CMS 1450' forms, and for what purpose?
What type of healthcare facilities primarily use 'UB-92/UB-04/CMS 1450' forms, and for what purpose?
Explain the impact of 'write-offs' on a healthcare provider's revenue cycle.
Explain the impact of 'write-offs' on a healthcare provider's revenue cycle.
In what circumstances would a healthcare provider need a patient to complete a 'W-9 form'?
In what circumstances would a healthcare provider need a patient to complete a 'W-9 form'?
How does HIPAA's mandate for the usage of NPI affect healthcare data exchange and interoperability?
How does HIPAA's mandate for the usage of NPI affect healthcare data exchange and interoperability?
If a patient receives a bill for a service they believed was covered, what steps should they take, considering the definition of 'non-covered charges'?
If a patient receives a bill for a service they believed was covered, what steps should they take, considering the definition of 'non-covered charges'?
Explain how 'timely filing limits' can create challenges for healthcare providers in managing their claims submission processes.
Explain how 'timely filing limits' can create challenges for healthcare providers in managing their claims submission processes.
Flashcards
National Provider Identifier (NPI)
National Provider Identifier (NPI)
A 10-digit, intelligence-free, numeric identifier for providers and suppliers issued by CMS; HIPAA mandates its use.
Non-Covered Charges
Non-Covered Charges
Service or procedure not listed as a covered benefit in the payer's master benefit list and may not be billable.
Policy Number / Member identification number / HIC number (Medicare)
Policy Number / Member identification number / HIC number (Medicare)
Number given by an insurance company to the policyholder to identify the contract.
Out of Network
Out of Network
Signup and view all the flashcards
Participating Provider (In-network provider)
Participating Provider (In-network provider)
Signup and view all the flashcards
Timely filing limit
Timely filing limit
Signup and view all the flashcards
UB-92 / UB-04 / CMS 1450
UB-92 / UB-04 / CMS 1450
Signup and view all the flashcards
Write off
Write off
Signup and view all the flashcards
W-9 Form
W-9 Form
Signup and view all the flashcards
Study Notes
- National Provider Identifier (NPI) is a 10-digit, intelligence-free, numeric identifier for providers and suppliers, issued by CMS, and its usage is mandated by HIPAA.
- Non-Covered Charges refer to a service or procedure not listed as a covered benefit in the payer's master benefit list, and these charges may or may not be billable to the patient.
- Policy Number, Member Identification Number, or HIC Number (Medicare) given by the insurance company helps the policyholder identify their contract.
- Out of Network refers to medical care sought from non-contracted providers, specifically those without contracts with specific managed care plans.
- Participating Provider (In-network provider) refers to a doctor or hospital contracted with the insurance company, having agreed to certain terms and payment conditions set by the insurance plan.
- Timely filing limit refers to the time frame payers give to providers to submit claims and get reimbursed.
- UB-92, UB-04 (Uniform billing 92 / 04), or CMS 1450 is a form used by hospitals to file insurance claims for medical services.
- Write off is the amount that is waived off by the provider, usually a loss borne by the provider.
- W-9 Form is a tax form that certifies an individual's tax identification number.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
