Exam 15: Filing the Claim Form

Verification of insurance eligibility can be done by using the Internet.

The provider number and the UPIN are one and the same and can be used interchangeably.

Some physicians are now beginning to carry a ________________________________________ to assist in tracking services provided outside of the office and document codes as well as time.

The _________________________ prohibits knowingly submitting false claims to government payers and/or submission of false records or statements to avoid an obligation to pay money to the government.

If a nurse practitioner is seeing patients in the office with no physician on site, the claim is billed as incident to the physician.

Insurance cards should be copied how often?

If an insurance plan considers the planned care to be a non-covered benefit, the patient is to sign an ABN _______.

Most insurance plans have limitations in coverage such as with preventative services.

Encounter forms should be updated how often?

Upcoding is selection of a code higher than supported by physician documentation.

HIPAA requires insurance plans and clearinghouses to use standard rejection codes and descriptions.

CMS will pay non-PAR physicians 10% lesser rate than PAR physicians.

Payments to the organization from any payer may vary and come in electronic format or check.

List four steps for and/or elements that must be documented when completing an ABN.

Physicians are reimbursed for professional services by the _________.

It is illegal to waive copays and coinsurances in the physician's office as a professional courtesy.

Birth dates are not required for the patient and spouse to determine whose insurance plan is responsible for payment.

The process of reviewing EOBs, posting payments, and determining if the payment amount is correct is called ____________________.

A typical form for capturing charges and codes for office services is the router form.

If your physician is non-PAR with Aetna and you need to obtain copies of their payment policies and procedures, you can request these from Aetna either in writing or via phone and they will send them directly to the physician.