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Medical Billing and Reimbursement Terms in this set (15)Electronic data interchange is: a) transferring data back and forth between two or more entities b) sending information to one insurance carrier c) sending information to one clearinghouse for processing d) None of the above a) transferring data back and forth between two or more entities To examine claims for accuracy and completeness before they are submitted is to _________ the claims. a) correct b) audit c) revise d) reject b) audit How many diagnoses can be reported on the CMS-1500? a) Two b) Three c) Four d) Six c) Four Claims that have errors or omissions that must be corrected and resubmitted to receive reimbursement are called _____________ claims. a) clean b) dirty c) dingy d) incomplete b) dirty Which of the following steps to medical billing should be performed prior to rendering medical services? a) Verify the patient's eligibility for insurance coverage b) Collect patient insurance information c) Code the diagnosis and procedures d) Both A and B d) Both A and B Which of the following is a fixed amount per visit and is typically paid at the time of medical services? a) Co-payment b) Deductible c) Co-insurance d) Both A and B a) Co-payment A(n) __________ claim has been completed accurately and completely. clean A claim that is missing information and is returned to the provider for correction and resubmission is called a(n) __________ claim. incomplete The medical assistant should __________ the front and back of the patient's insurance card. copy The medical assistant should do everything possible to prevent claim __________. rejection Dirty claims cannot be resubmitted. a) True b) False b) false
Only physicians can be providers of medical services. a) True b) False b) false Electronic claims are submitted via electronic media. a) True b) False a) true Claims that are done by direct billing first go to a clearinghouse. a) True b) False b) false The insurance claim should always be proofread. a) True b) False a) true Sets with similar termsMedical Coding8 terms csf2910 Health Informatics Pathways and Careers52 terms xxibmaddii medical office assistant ncct37 terms brandi_leigh_uiselt Billing & Coding Clear & Simple Unit144 terms mshred62 Sets found in the same folderChapter 15 Review43 terms jenflo1 CMA Certification Exam: Pretest 3100 terms bvance2 Medical Assistant Certification Exam379 terms danielle_ivey6 Medical Terminology Chapter 986 terms kailegais Other sets by this creatorAMT RMA Exam Prep170 terms pantojadaisy Module 01 Test12 terms pantojadaisy MA 106 Diagnostic & Specialty58 terms pantojadaisy Abbreviations12 terms pantojadaisy Other Quizlet setsGeography 115 Exam #199 terms yg0371-PLUS AP II Exam #3: Lymphatic System174 terms jessica_roache8 Direito Financeiro - Quizlet93 terms Ivila_Soares Related questionsQUESTION According to the AST position statement on teamwork, which type of environment contributes most to a safe and efficient surgical experience with positive patient outcomes? 15 answers QUESTION Which action would a nurse identify as the current focus of today's practice informatics? 13 answers QUESTION Because HIT leaders are not concerned with their reputations, they are always honest regarding their HIT failures. They always document 100% of their failures so that future efforts can benefit and avoid their mistakes. 6 answers QUESTION The process by which claims are submitted directly to the insurance carrier is called: 9 answers Which of the following occurs when claims are submitted in batches using a clearinghouse?When a batch of claims are submitted electronically to a clearinghouse a report is sent to the provider. What feedback does this report from the clearinghouse identify? All claims sent to the payer and all rejected claims. Typically, within 24 hours the clearinghouse will send a report to the provider.
Which of the following steps to medical billing should be performed?Which of the following steps to medical billing should be performed prior to rendering medical services? Preauthorization specifically determines the dollar amount approved for the medical procedure, while precertification gives the provider approval to render the medical service.
What are the disadvantages of using a clearinghouse for electronic claims submission?Potential Drawbacks of Clearinghouses. Juggling multiple clearinghouses. The primary purpose of a clearinghouse is to streamline billing. ... . Cost. You need to pay to use a clearinghouse, so you'll need to look at how this service affects your budget. ... . No guarantees. ... . HIPAA compliance issues.. What is the term for submitting insurance claims via wire to a clearing house or directly to the insurance carrier?dirty. claims are claims that are submitted to insurance processing facilities using a computerized medium, such as direct data entry, direct wire, dial-in-telephone digital fax, or personal computer download or upload. .
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Claims that are done by direct billing first go to a clearinghouse
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