Chapter 4 Flashcards
Define guarantor
The person who is ultimately responsible for payment to the medical office
Define Assignments of Benefits Form
Patient wishes insurance payments to be made directly to the provider
Define release of information form
A claim can only be submitted to an insurance carrier on the patient’s behalf
How often should the medical office request that the patient sign and update a release of information form?
Once a year
Define clearinghouse
A company that receives a claim from providers, audits tehm, and forwards them on to insurance carriers
What is listed on an Audit-Edit report form a clearinghouse?
Claims that need corrections, claims that are missing information, claims forwarded to the insurance carrier
Define encryption
Scrambling electronic information during transmission to prevent it from being intercepted by unauthorized users
Pertaining to the CMS 1500 form, what does the acronym OCR refer to?
optical character recognition
Who issues the Employer Identification number or federal tax ID number?
IRS
What is the identification number issued to physicians who are authorized to practice medicine in a given state?
State license number
Define dirty claim
Information is missing from a claim when it is submitted to an insurance carrier
Explain the birthday rule
The parents whose date of birth is earliest in the year
When will the coordination of benefits be used
The determination of how claims will be paid by each insurance plan
Define supplemental insurance
A limited insurance policy purchased to cover part of the patient’s expenses, for which the patient would be otherwise responsible
Who developed the cms-1500 claim form
The centers for medicare and medicaid
What is the subsection of HIPPA that regulates electronic billing
Administrative Simplification
Who are covered entities according to HIPPA?
Health plans, clearinghouses, billing services, and providers
On the CMS-1500 claim form what does EMG mean?
Emergency services
On the CSM-1500 claim form what does NPI stand for?
National Provider Identifier
On the CSM-1500 claim form what does EIN stand for?
Employer Identification Number
