Exam 13: Claim Processing, Payments, and Collections

A (n) ______ is a process that can be used to challenge a payer's decision to deny, reduce or otherwise downcode a claim.

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 ______.

Classification of accounts receivable by length of time is called _____.

Claims may be downcoded because_____.

If a claim has been denied or payment reduced, what is filed with the payer for reconsideration?

_______ prohibits credit discrimination based on race, color, religion, national origin, sex, marital status, age, or because a person receives public assistance.

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

_____ are laws regulating collection practices.

________ shows services provided to a patient, total payments made, total charges, adjustments, and balance due.

To avoid late payments from payers, medical assistants regularly review the __________.

All activities related to patient accounts and follow-up are called ______.

A (n) _________ is made when the practice has overcharged a patient for a service and the patient has a credit balance.

To file a claim appeal, the physician should submit a (n) ____.

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

Electronic routing of funds between banks is called ______.

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

To improve the rate of paid claims over time, medical assistants_____.

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

What is the report summarizing the business day's charges and payments called?

After the practice has exhausted all of its collection efforts and a patient's balance is still unpaid, the account may be labeled as a (n) ______.