Insurance Chapter 4

Front 1

Which organization facilitates the development of standards for health informatics and other industries such as the international exchange of good and services?

Back 1

ANSI

Front 2

Approximately how many billion insurance claims are filed each year

Back 2

6

Front 3

Processing a claim begins when??

Back 3

Physician's office

Front 4

What type of claim is generated for providers who do not accept assignment

Back 4

Unassigned

Front 5

According to national standards mandated by HIPAAfor the electronic exchange of administrative and financial health care transactions which would be a covered entity?

Back 5

managed care organizations (MCO)

Front 6

The specified percentage of charges the patient must pay to the provider for each service received or for each visit is the ___

Back 6

Coinsurance

Front 7

The remittance advice is called what by the Medicare program

Back 7

PRN

Front 8

The insurance industry is regulated by individual

Back 8

States

Front 9

Data transmitted electronically or manually to payers or clearinghouses is called claims ____

Back 9

Submission

Front 10

The rule stating that the policyholder whose birth month and day occur earlier in the calendar year holds the primary policy for dependent children is what rule

Back 10

Birthday Rule

Front 11

The patient account record that can be found in automated or manual format is also called the ___

Back 11

Patient Ledger

Front 12

A procedure reported on a claim that is not included on the master benefit list will result in what ____

Back 12

Denial

Front 13

The person responsible for paying the chargers for services rendered by the provider is the ___

Back 13

Guarantor

Front 14

If a claim is found to contain all data elements needed for processing, it is known as a what kind of claim

Back 14

Clean

Front 15

Care rendered to a patient was not properly approved by the insurance company is known as what type of service

Back 15

Unauthorized

Front 16

What allows for the direct submission of claims to payers using internet technology that emulates a system connection

Back 16

Extranet

Front 17

The maximum amount the payer will allow for each procedure or service, according to the patient's policy is the ____ charge

Back 17

allowed

Front 18

The processing of a claim consists of how many stages

Back 18

Four

Front 19

The financial record source document used to record services rendered in a physician's office is the ____

Back 19

encounter form

Front 20

When the provider is required to receive as payment in full whatever amount the insurance reimburses for services, the provider is agreeing to accept

Back 20

Assignment

Front 21

How many years must providers retain copies of government insurance Claims

Back 21

Six

Front 22

What is used to create the patient's financial and medical records

Back 22

Patient registration form

Front 23

What is submitting multiple CPT codes when just one code should have been submitted

Back 23

Unbundling

Front 24

When there isn't CPT or HCPCS Level II code what does the provider have to submitted to the payer

Back 24

Supported documentation