Exam 4: Processing an Insurance Claim

When selecting a clearinghouse, providers may also want to determine whether it is accredited by the __________.

Coordination of benefits (COB) is a provision in __________ health insurance policies intended to keep multiple insurers from paying benefits covered by other policies.

The computer-to-computer transfer of data between providers and third-party payers (or providers and health care clearinghouses) in a data format agreed upon by sending and receiving parties is called electronic __________.

When a child lives with both parents, and each parent subscribes to a different health insurance plan, the primary and secondary policies are determined by applying the birthday rule. The individual who holds the primary policy for dependent children is the spouse whose birth __________.

A claims attachment is __________ documentation associated with a health care claim or patient encounter.

Which is the financial record source document used by health care providers and other personnel in a hospital outpatient setting to select codes for treated diagnoses and services rendered to the patient during the current visit?

Which is a computerized permanent record of all financial transactions between the patient and the practice?

Which is an electronic format supported for health care claims transactions?

Which are the amounts owed to a business for services or goods provided?

Which states that third-party debt collectors are prohibited from employing deceptive or abusive conduct in the collection of consumer debts incurred for personal, family, or household purposes?

Which claims are filed according to year and insurance company and include those for which all processing, including appeals, has been completed?

Health insurance plans may include a(n) __________ provision, which means that when the patient has reached that limit for the year, appropriate patient reimbursement to the provider is determined.

Which involves sorting claims upon submission to collect and verify information about the patient and provider?

Dr. Smith is a participating provider (PAR) for the ABC Health Insurance Plan. Mary Talley is treated by Dr. Smith in the office, for which a $100 fee is charged. Given the information in the table located below, calculate the PAR provider write-off amount.

Which is the financial record source document used by health care providers and other personnel in a physician's office setting to record treated diagnoses and services rendered to the patient during the current visit?

A remittance advice submitted to the provider electronically is called an electronic remittance advice (ERA), and __________.

When dealing with delinquent claims, it is important to review records to determine whether the claim was paid, was denied, or is pending. A pending claim is considered in __________.

Which is the financial record source document used by health care providers and other personnel to record treated diagnoses and services rendered to the patient during the current visit?

Which claims are organized by year and are generated for providers who do not accept assignment?

Which is considered a financial source document from which an insurance claim is generated?