| Question Answer | Assists providers in the collection of appropriate reimbursement for services rendered; include functions such as insurance verification/eligibility and preauthorization of services. Accounts Receivable Management |
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Which person is responsible for paying the charges?
| Question Answer | The person responsible for paying the charges for services rendered by the provider is the Guarantor | Which document is used to generate the patient’s financial and medical record? Patient registration form |
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Which means that the patient and/ or insured has authorized the payer to reimburse the provider directly?
Medicaid Summary Notice
.
Which means the provider agrees to accept what the insurance company allows or approves as payment in full for the claim?
Accept assignment
: means the provider agrees to accept what the insurance company allows or approves as payment in full for the claim. Allowed charges: … the patient and/or insured authorize the payer to reimburse the provider directly.
Which is submitted to the payer requesting reimbursement?
| Question Answer | The documentation submitted to the payer requesting reimbursement is called a… Health Insurance Claim | The Centers for Medicare and Medicaid Services (CMS) was previously called the…. Health Care Financing Administration | A health care practitioner is also calle a… Provider |
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Is patient responsible for billing?
Patient responsibility is
the portion of a medical bill that the patient is required to pay rather than their
insurance provider. For example, patients with no health insurance are responsible for 100% of their medical bills.
What is the process of collecting appropriate reimbursement for services rendered?
| Question Answer | Assists providers in the collection of appropriate reimbursement for services rendered; include functions such as insurance verification/eligibility and preauthorization of services. Accounts Receivable Management |
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What are five reasons a claim might be denied for payment?
- Your claim was filed too late. …
- Lack of proper authorization. …
- The insurance company lost the claim and it expired. …
- Lack of medical necessity. …
- Coverage exclusion or exhaustion. …
- A pre-existing condition. …
- Incorrect coding. …
- Lack of progress.
Which is the right of individuals to keep their information from being disclosed to others?
| Question Answer | Which term describes an individual’s right to keep healthcare information from being disclosed to others? privacy | The safekeeping of patient information by controlling access to hard-copy and computerized records is a form of____. Security Management |
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Which is the fixed amount the patient pays each time?
| Which means that the patient and/or insured has authorized the payer to reimburse the provider directly? assignment of benefits | Which is the fixed amount patients pay each time they receive health care services? copayment |
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What is it called when an insurance company pays a provider?
Co-payment (Co-pay)
A predetermined, fixed fee that you pay at the time of service. Copayment amounts vary by service and may vary depending on which provider (in-network, out-of-network, or provider type) you see. The amounts also may vary based on the type of service you are receiving (for instance, primary care vs.
When a provider is non participating they will expect?
When submitting a claim for a patient with coverage through more than one BCBS plan: submit a claim for the primary insurance, then submit the secondary claim. When a provider is non-participating, they will expect:
full reimbursement for charges submitted
.
What does coordination of benefits allow?
Coordination of benefits (COB) allows
plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities
(i.e., determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an …
Which is submitted to the payer requesting reimbursement group of answer choices?
The document submitted to the payer requesting reimbursement is called an….
Health insurance claim
.
What type of insurance is needed for protection against this loss for the client?
Professional liability insurance
is used in businesses to protect against claims of negligence. Professionals such as accountants and doctors use this insurance to protect themselves against client claims of negligence or malpractice.
Which is the amount for which the patient is financially responsible?
| Question Answer | Amount for which the patient is financially responsible before an insurance policy provides coverage. deductible | Reimbursement for income lost as a result of a temporary or permanent illness or injury. disability insurance |
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