MOA Chapter 18: Medical Billing Flashcards

A process completed before claims submission in which claims are examined for accuracy and completeness.

A payment arrangement for healthcare providers where the provider is paid a set amount for each enrolled person per period of time, regardless of services received.

<p>Meeting the stipulated requirements to participate in the healthcare plan.</p> Signup and view all the answers

<p>Services or supplies used to treat a patient's diagnosis that meet the accepted standard of medical practice.</p> Signup and view all the answers

<p>An identifier assigned by the Centers for Medicare and Medicaid Services (CMS) that classifies the healthcare provider by license and medical specialties.</p> Signup and view all the answers

<p>The process of determining if a procedure or service is covered by the insurance plan and what the reimbursement is.</p> Signup and view all the answers

<p>A statement that indicates the patient's deductible and/or coinsurance.</p> Signup and view all the answers

<p>collecting patient</p> Signup and view all the answers

<p>Office policies related to claims processing.</p> Signup and view all the answers

<p>Gives the provider approval to render the medical service.</p> Signup and view all the answers

<p>Call the provider services number, provide procedures and diagnosis, document the outcome.</p> Signup and view all the answers

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

<p>Insurance claims transmitted over the internet from provider to health insurance company.</p> Signup and view all the answers

<p>The electronic transfer of data between two or more entities.</p> Signup and view all the answers

<p>The process by which an insurance company allows a provider to electronically submit claims directly.</p> Signup and view all the answers

<p>Acts as a go-between for the healthcare facility and insurance company.</p> Signup and view all the answers

<p>Audits the claims for completeness.</p> Signup and view all the answers

<p>By the birthday rule where the parent's birth date that occurs first in the year is considered primary.</p> Signup and view all the answers

<p>Up to 12</p> Signup and view all the answers

<p>A holistic approach to medical care.</p> Signup and view all the answers

<p>Knowingly executing a scheme to defraud a healthcare benefit program.</p> Signup and view all the answers

<p>Actions contrary to ethical standards that result in overpayment to providers.</p> Signup and view all the answers

<p>Claims without errors of any type.</p> Signup and view all the answers

<p>Claims with incorrect, missing, or insufficient data.</p> Signup and view all the answers

<p>insured subscriber's member number</p> Signup and view all the answers

<p>Based on diagnostic and procedural codes submitted on the claim.</p> Signup and view all the answers

<p>A set dollar amount that the policyholder is responsible for before insurance begins to reimburse.</p> Signup and view all the answers

<p>The insured and the insurance company share the cost of covered medical services after the deductible has been met.</p> Signup and view all the answers