Ch 5: Review Test Flashcards
Claim Submission Methods
What are the two basic methods of submitting health insurance claims?
- Electronic
- Paper
The health insurance claims process is an interaction between the healthcare provider and who?
Insurance company
Services or supplies that are appropriate and necessary for the symptoms, diagnosis, and treatment of the medical condition and meet the standards of good medical practice are called what?
Medical necessity
What modern innovation has made claims submission faster and more accurate at a cost savings to medical practices?
Computer technology
A “small provider” of services is one with fewer than ____?
25 full-time equivalent employees
The patient information form is a legal document and should be updated no less often than ____?
Once a year
A patient’s name, address, Social Security number, and employment data are commonly referred to as what?
Demographic information
What is an individual covered under Medicare referred to as?
Beneficiary
An insurance policy that covers an individual, his or her spouse, and eligible dependents is referred to as a ____?
Family plan
What three multipurpose forms are used by most medical practices for billing?
- Superbill
- Encounter form
- Routing form
In non-computerized practices, patient charges and payments can be tracked manually on a ____?
Patient ledger card
What standard unique identifier was adopted to identify all healthcare providers and health plans?
National Provider Identifier (NPI)
A company that receives claims, consolidates them, and transmits them in batches to third-party payers is called a ____?
Clearinghouse
What new version of the HIPAA standards were implemented in January 2010?
Version 5010
The new HIPAA standards (January 2010) addresses many of the deficiencies in the former version and accommodates the reporting of what two things?
- National Provider Identifiers (NPIs)
- The new ICD-10 codes
