Chapter 1: Reimbursement Flashcards
What happens after the insurance carrier processes the claim?
Sends the payment directly to the provider.
What happens after the payment is sent to the provider?
It generates a Remittance Advice, sends it to the provider to explain how the reimbursements were determined.
The amount that an insurance company pays for the services in a claim depends on the?
Policy’s Allowable Charges.
The remittance advice also tells the provider the amount the patient is responsible for paying such as?
Remaining deductible, copayment or coinsurance.
What contains the claim information for multiple patients and requires careful review for “reaso codes” or “remarks” for unpaid claims?
The RA.
What happens after the billing specialist has reviewed the remittance advice?
They post the insurance payment and any patient liability amount to the appropriate patient account.
What is the name of the summary of the insurance payment that the patient receives?
Explanation of Benefits (EOB)
What does most Clearinghouse offer?
An electronic remittance advice (ERA).
What does Electronic funds transfer (EFT)?
Services.
Electronic Remittance Advice (ERA) is the electronic version of?
The paper-style remittance advice.
Electronic Funds Transfer (EFT) is the direct deposit of reimbursements into?
The provider’s designated bank account.
What is the maximum amount that an insurer will reimburse for a covered service or procedure?
The Allowable Charge.
