MED134 - Final Flashcards

Classification of accounts receivable by length of time.

To report the status group for a claim.

<p>To provide a detailed answer to a claim status inquiry.</p> Signup and view all the answers

<p>Time period in which a health plan must process a claim.</p> Signup and view all the answers

<p>The mandated paper insurance claim form.</p> Signup and view all the answers

<p>A guide published by a payer that lists its own set of claim edits and formatting conventions.</p> Signup and view all the answers

<p>Claim billed to Medicare and then submitted to Medicaid.</p> Signup and view all the answers

<p>Smallest unit of information in a HIPAA transaction.</p> Signup and view all the answers

<p>Payer's decision about the benefits due for a claim.</p> Signup and view all the answers

<p>Development.</p> Signup and view all the answers

<p>A condition that data must meet to be selected.</p> Signup and view all the answers

<p>HIPAA standard format for electronic transmission of the claim to a health plan.</p> Signup and view all the answers

<p>Electronic format used to ask payers about claims.</p> Signup and view all the answers

<p>Report that lists how long a payer has taken to respond to insurance claims.</p> Signup and view all the answers

<p>Refusal by a plan to pay for a procedure that does not meet its medical necessity criteria.</p> Signup and view all the answers

<p>National Uniform Claim Committee.</p> Signup and view all the answers

<p>Buttons that simplify the task of moving from one entry to another.</p> Signup and view all the answers

<p>Claim status in which the payer is waiting for information before making a payment decision.</p> Signup and view all the answers

<p>State laws that mandate a time period within which clean claims must be paid.</p> Signup and view all the answers

<p>Claim status when the payer is developing the claim.</p> Signup and view all the answers

<p>Health plan's rules specifying the number of days after the date of service that the practice has to file the claim.</p> Signup and view all the answers

<p>1</p> Signup and view all the answers

<p>150</p> Signup and view all the answers

<p>1,054</p> Signup and view all the answers

<p>subscriber</p> Signup and view all the answers

<p>insured</p> Signup and view all the answers

<p>claim filing indicator code</p> Signup and view all the answers

<p>Provider = The entity supplying the service Subscriber = The insurance policyholder Payer = The entity responsible for payment Claim details = Information regarding the specific service provided Services = Procedures performed for a patient</p> Signup and view all the answers

<p>The HIPAA transaction for electronic claims generated by physicians for professional services.</p> Signup and view all the answers

<p>The HIPAA transaction for electronic claims generated by hospitals (institutional services).</p> Signup and view all the answers

<p>The HIPAA transaction for electronic claims generated by dentists.</p> Signup and view all the answers

<p>Providers and payers exchange transactions directly without using a clearinghouse.</p> Signup and view all the answers

<p>medical practice</p> Signup and view all the answers

<p>Method of claim transmission in which a member of the provider's billing staff manually enters claims in an application on the payer's website.</p> Signup and view all the answers

<p>When a clearinghouse is used, claims can be sent in one batch to one location.</p> Signup and view all the answers

<p>Medicare = First payer for claims Medicaid = Referred to as the 'payer of last resort'</p> Signup and view all the answers

<p>An electronic acknowledgment of the file transmission sent by a payer after receiving a claim.</p> Signup and view all the answers

<p>An acknowledgment that the claim has been received.</p> Signup and view all the answers

<p>Indicates that a claim is pending.</p> Signup and view all the answers

<p>Indicates that the claim has been finalized.</p> Signup and view all the answers

<p>Indicates that a request for more information has been sent.</p> Signup and view all the answers

<p>Indicates an error has occurred in transmission.</p> Signup and view all the answers

<p>Manual Review</p> Signup and view all the answers

<p>Document describing a payment resulting from a claim adjudication.</p> Signup and view all the answers

<p>Electronic document that lists patients, dates of service, charges, and the amounts paid or denied by the insurance carrier.</p> Signup and view all the answers

<p>The ERA mandated for use by HIPAA.</p> Signup and view all the answers

<p>Unique number assigned to a claim by the sender.</p> Signup and view all the answers

<p>Software feature enabling automatic entry of payments from a remittance advice.</p> Signup and view all the answers

<p>Used on an RA/EOB to indicate the general type of reason code for an adjustment.</p> Signup and view all the answers

<p>Used on an RA/EOB to explain why a payment does not match the amount billed.</p> Signup and view all the answers

<p>Code that explains a payer's payment decision.</p> Signup and view all the answers

<p>Patient responsibility.</p> Signup and view all the answers

<p>Contractual obligations.</p> Signup and view all the answers

<p>Corrections and reversals.</p> Signup and view all the answers

<p>Other adjustments.</p> Signup and view all the answers

<p>Payer-initiated reduction.</p> Signup and view all the answers

<p>Electronic routing of funds between banks.</p> Signup and view all the answers

<p>Payments made to physicians on a regular basis for providing services to patients in a managed care plan.</p> Signup and view all the answers

<p>A process that can be used to challenge a payer's decision to deny, reduce, or otherwise downcode a claim.</p> Signup and view all the answers

<p>Person or entity exercising the right to receive benefits.</p> Signup and view all the answers

<p>Person who appeals a claim decision.</p> Signup and view all the answers

<p>An appeal</p> Signup and view all the answers

<p>Has the authority to review appeals that payers reject.</p> Signup and view all the answers

<p>Review conducted after a claim is adjudicated.</p> Signup and view all the answers

<p>Entity that audits Medicare claims to recover incorrect payments.</p> Signup and view all the answers

<p>45</p> Signup and view all the answers

<p>Improper or excessive amount received by a provider from payer.</p> Signup and view all the answers

<p>Balance that a provider owes a payer following a post-payment audit.</p> Signup and view all the answers

<p>List of the amount of money a patient owes, the procedures performed, and the dates they were performed.</p> Signup and view all the answers

<p>Document showing how the amount of a benefit was determined.</p> Signup and view all the answers

<p>Statements that show all charges regardless of whether the insurance carrier has paid.</p> Signup and view all the answers

<p>Statements that list only charges that are not paid in full after all insurance carrier payments.</p> Signup and view all the answers

<p>A summary of patient activity on a given day.</p> Signup and view all the answers

<p>A report that lists all the procedures performed on a particular day.</p> Signup and view all the answers

<p>A report that lists all payments received on a particular day, organized by provider.</p> Signup and view all the answers

<p>A report that lists the amount of money owed to the practice, organized by the amount of time the money has been owed.</p> Signup and view all the answers

<p>A report that lists a patient's balance by age, date, and the amount of the last payment.</p> Signup and view all the answers

<p>Gives bonuses to physicians who report to the Medicare program about their use of recognized ongoing performance measurements.</p> Signup and view all the answers

<p>Processes, experience, and/or outcomes of patient care that relate to quality aims for healthcare.</p> Signup and view all the answers

<p>6</p> Signup and view all the answers

<p>Requires covered entities to implement policies and procedures to address final disposition of ePHI.</p> Signup and view all the answers

<p>A report that lists the financial activity in each patient's account including charges, payments, and adjustments.</p> Signup and view all the answers

<p>35</p> Signup and view all the answers

<p>A reminder to follow up on an account.</p> Signup and view all the answers

<p>Federal law regulating collection practices enforced by the Federal Trade Commission.</p> Signup and view all the answers

<p>Regulates collection practices related to finance charges and late fees.</p> Signup and view all the answers

<p>Law that prohibits credit discrimination on various bases.</p> Signup and view all the answers

<p>Agreement between a patient and a practice for regular monthly payments.</p> Signup and view all the answers

<p>Account that does not respond to collection efforts.</p> Signup and view all the answers

<p>Process of fairly determining a patient's ability to pay.</p> Signup and view all the answers

<p>A balance that has been removed from a patient's account.</p> Signup and view all the answers

<p>Declaration that a person is unable to pay his or her debts.</p> Signup and view all the answers

<p>Overdue patient account in which the amount owed is less than the cost of pursuing payment.</p> Signup and view all the answers