Medical Billing Chapter 17 Flashcards

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Questions and Answers

What does 'third party reimbursement' indicate?

Payment of services by the provider

Payment of services by the patient

Payment of services by someone other than the patient (correct)

Payment of services by the government

When have providers been urged to send claims electronically?

Since 2005

What is the CMS 1500 form used for?

Billing in medical offices

What are common claim errors?

Errors found from third party payers Signup and view all the answers

What does NPI stand for?

National Provider Identifier Signup and view all the answers

What should you check for when completing a claim form?

A photocopy of the patient's insurance card Signup and view all the answers

Medicare will only accept handwritten signatures.

False Signup and view all the answers

What is the benefit of filing claims electronically?

Shortened turnaround time Signup and view all the answers

Match the following forms with their corresponding names:

CMS 1500 = Standard claim form for medical billing CMS 1450 = UB-40 form Signup and view all the answers

What do clearinghouses charge providers for?

Services with fees based on volume Signup and view all the answers

How quickly is payment received via electronic claims tracking?

Usually within 24 hours Signup and view all the answers

What is one advantage of electronic claims tracking?

Reduction of lost time Signup and view all the answers

What is a consequence of manual claims tracking?

Payment delays Signup and view all the answers

What should be done for delinquent claims?

Follow up after the appropriate time period Signup and view all the answers

What is a remittance Medicare?

Multipurpose form accompanying payments Signup and view all the answers

What should be posted to the account after an insurance adjustment?

Amount of the insurance adjustment Signup and view all the answers

What information should be included in the procedure steps?

Insurance company name and payment date 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.

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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.