Podcast
Questions and Answers
What does 'third party reimbursement' indicate?
What does 'third party reimbursement' indicate?
When have providers been urged to send claims electronically?
When have providers been urged to send claims electronically?
Since 2005
What is the CMS 1500 form used for?
What is the CMS 1500 form used for?
Billing in medical offices
What are common claim errors?
What are common claim errors?
Signup and view all the answers
What does NPI stand for?
What does NPI stand for?
Signup and view all the answers
What should you check for when completing a claim form?
What should you check for when completing a claim form?
Signup and view all the answers
Medicare will only accept handwritten signatures.
Medicare will only accept handwritten signatures.
Signup and view all the answers
What is the benefit of filing claims electronically?
What is the benefit of filing claims electronically?
Signup and view all the answers
Match the following forms with their corresponding names:
Match the following forms with their corresponding names:
Signup and view all the answers
What do clearinghouses charge providers for?
What do clearinghouses charge providers for?
Signup and view all the answers
How quickly is payment received via electronic claims tracking?
How quickly is payment received via electronic claims tracking?
Signup and view all the answers
What is one advantage of electronic claims tracking?
What is one advantage of electronic claims tracking?
Signup and view all the answers
What is a consequence of manual claims tracking?
What is a consequence of manual claims tracking?
Signup and view all the answers
What should be done for delinquent claims?
What should be done for delinquent claims?
Signup and view all the answers
What is a remittance Medicare?
What is a remittance Medicare?
Signup and view all the answers
What should be posted to the account after an insurance adjustment?
What should be posted to the account after an insurance adjustment?
Signup and view all the answers
What information should be included in the procedure steps?
What information should be included in the procedure steps?
Signup and view all the answers
Study Notes
Third Party Reimbursement
- Refers to payment for services provided by a third party, not the patient.
History of Claims
- Providers encouraged to submit claims electronically since 2005.
- Compliance with HIPAA is essential for reimbursement processes.
CMS 1500 Form
- Standard claim form used in medical offices.
- Accepted by Medicare, Medicaid, and most health insurance groups for reimbursement.
Common Claim Errors
- Errors detected by third-party payers can lead to claim rejection.
- Medical facilities must resubmit corrected claims upon rejection.
National Provider Identifier (NPI)
- Unique identification for healthcare providers in a 10-digit format.
Procedure to Complete a Claim Form
- Ensure a photocopy of the patient's insurance card is available before submission.
Medicare Signature Acceptance
- Medicare accepts stamped signatures; other carriers accept typed names and credentials as valid signatures.
Filing Claims Electronically
- Reduces turnaround time and preparation time for claims processors.
- Enhances efficiency in the claims filing process.
CMS 1450 Form
- Also known as the UB-40 form, used for institutional claims.
Clearinghouses
- Facilitate claims processing for providers, charging fees such as startup, monthly, or per-claim transaction fees based on volume.
Electronic Claims Tracking
- Claims typically reach payers within 24 hours, accelerating payment processes.
- Online tracking allows real-time updates and alerts for claim issues.
Manual Claims Tracking
- Involves a lengthy process that can lead to payment delays.
Delinquent Claims
- Claims not paid within designated periods require follow-up if no denial is received.
Remittance Medicare
- A multipurpose form necessary with payments sent to the Federal Communications Commission.
Procedure Payments and Adjustments to Patient Accounts
- Insurance adjustments must be recorded in the credit column of patient accounts.
Procedure Steps
- Document the name of the insurance company, payment date, and adjustment details for records.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge on key terms from Chapter 17 of medical billing. This quiz includes definitions and concepts such as third party reimbursement, history of claims, and the CMS 1500 form. Perfect for students preparing for exams in healthcare administration.