Exam 13: Claim Processing, Payments, and Collections

Monitoring claims during adjudication requires two types of information: the amount of time the payer is allowed to take to respond to the claim, and ______.

Appeals are sent by patients or providers to payers to _______.

The process of _______ means making sure that the totals on the RA check out mathematically with the expected payments.

Account deemed uncollectible is called ______.

Record of a patient's financial transactions is called _____.

The process that payers follow to examine claims and determine payments is called ___.

A (n) ______ explains the adjustment on the insured's account.

Health plan process of examining claims and determining benefits is called _____.

______ is a payer's decision about paying a health care claim.

A claim appeal is a written request for a ______.

What is the first step in answering patients' inquiries about claims?

______ is a type of billing which divides patients with current balances into groups to even out monthly statement printing and mailing.

Payer's decision about the benefits due for a claim is called ____.

The term used by payers to indicate that more information is needed for claim processing is called _____.

_____ has laws regulating consumer collections to ensure fair and ethical treatment of debtors.

What document shows which patient's payments are due or overdue?

EOB is the abbreviation for ______.

________ is a report grouping unpaid claims transmitted to payers by the length of time they remain due.

When the level of service is reduced by the claims examiner, it is known as ____.

______ is the use of a procedure code that provides a higher payment.