Medical Billing Chapter 17 Flashcards

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.

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.