B&C Chapter 11: CMS-1500 and UB-04 Claims Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

ANSI ASC X12N 837I

A

standard format for submission of electronic claims for institutional health care services.

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2
Q

ANSI ASC X12N 837P

A

standard format for submission of electronic claims for professional health care services.

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3
Q

billing entity

A

the legal business name of the provider’s practice.

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4
Q

data packets

A

Format of electronic claims transmission, where are routed between provider and billing company, clearinghouse, or payer using the Internet or other packet-exchange network.

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5
Q

diagnosis pointer letters

A

item letters A through L preprinted in Block 21 of the CMS-1500 claim.

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6
Q

Federal Privacy Act

A

enacted in 1974 to prohibit a payer from notifying the provider about payment or rejection of unassigned claims or payments sent directly to the patient or policyholder.

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7
Q

hospitalist

A

dedicated inpatient physician who works exclusively in a hospital.

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8
Q

Medicare supplemental plan

A

covers the Medicare deductible and copay or coinsurance amounts that patients pay for receiving health care through Medicare.

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9
Q

National Council for Prescription Drug Programs (NCPCP) Telecommunication Standard

A

standard format for retail pharmacy.

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10
Q

National Plan and Provider Enumeration System (NPPES)

A

developed by CMS to assign unique identifiers to health care providers (NPI).

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11
Q

supervising physician

A

a licensed physician in good standing who, according to state regulations, engages in the direct supervision of nurse practitioners and/or physician assistants whose duties are encompassed by the supervising physician’s scope of practice.

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12
Q

UB-04

A

insurance claim or flat file used to bill institutional services, such as services performed in hospitals.

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