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69 Cards in this Set

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Bill type 111

Inpatient Original

Bill type 117



Inpatient Corrected Claim

Bill type 118

Inpatient Void Claim

Bill type 131

outpatient original claim

Bill type 137

outpatient corrected claim


Bill type 138

outpatient void claim

PR-1 Is the non-medical code for

deductible

Pr-2 is the non-medical code for

coins



PR-3 is

co-payment

Which insurance is the payer of the last resort?

Medicaid (always last)

TOB can be found in which FL?

field locator 04



RA/835 is distributed to..

the provider



ABN

advanced beneficiary notice(medicare patients)

CO remark code stands for

contractual obligation (non-medical group code)

MSP

medicare secondary payer

DRG

diagnosis related groups. the rate at which inpatient claims are processed, direct

HCFA claim form is for ___

hospital claims

UB-04

uniform bill

NPI (10 digits)

national provider identifier

UB-04 does not require revenue code

false, those codes are 960-999

The allowed amount is the maximum allowed amount that

the insurance pays to the provider

TOB

type of bill

APC

ambulatory payment classification (outpatient)

HMO

health maintenance organization. a network of providers. capitated rate.



PPO

preferred provide organization. Hospital/health service group that offers collective healthcare services under contract to employees. Can go to whatever hospital they choose. Flexible but more expensive

Anytime you see a percentage, it's....

coins

Cash App Form

form we fill out when payments are missing so client can review it and apply it to the correct patient

PR-1, PR-2, PR-3 are example of medical or non-medical codes?

non-medical

PR26

expenses occurred before coverage

PR96

non-covered charges

PHI

protected health information



When calling insurance what are your 3 bullet points

-know why you're calling


-know relevant info


-use other accounts

DCN

form to use when correcting a claim

HSA

health savings account. allows people to deposit savings for medical expenses tax-free

FSA

flexible spending account. money put aside from your check to pay for qualified medical expenses. does not roll over at the end of the year.

Medicare if for those 65 & older or

disabled.


part a- mandatory


part b- outpatient care


part c- prescription drugs


part d- covers prescription drugs coverage

Workers comp required if over ___ employees

5

FCR (First Call Resolution)

-first call last call


-what is preventing payment?


-Resolve (rebill, payment, sent to HIM?)


-have all my questions been answered?

Before calling make sure you have all info such as....

-why you're calling


-have all important, relevant info like name, dob, dos, billed amount


-reason for calling


-additional accouts

For "promise to pay" accounts make sure to always get

the check/eft number

HIPPA

healthcare insurance portability and accountability act

Resq status code 0000

new work

Resq status code 0001

returned work

Resq satus code 5101

coding issues pending review

Resq status code 8803

zero balance

NCOF

no claim on file

Account balances will either be (5 things)

-payments


-contractual adjustment


-denied charge


-PR


-unfiled/late charge

The claim number is signed to a specific

dos

9999999IN is an example of what

a medicare patient on a eob

RA's are sent from the ___ to the ____

insurance to the provider

Medical & non-medical codes can be fund on a

RA & EOB

Imaging systems hold EOBs not

patient accounting systems

Ancillary charge (tob)

121

skilled nursing facilities (SNF) are

hospices

DDE

database for medicare claims

APC

ambulatory payment classification. how a claim is paid

NDC

national drug code. info such as milligrams & quantity.


-ndc's & j code appear together, j codes tell a specific type of drug

Doctors send ____ to the insurance

UB-04's

CMS 1500 (HCFA) just like a UB-04 is used for

professional billing

To find the contractual adjustment on an eob subtract the

allowed amount from the billed amount

modifiers are the 2 digits after a

hcpcs code

DPD

detailed procedure document

3-5 digits with a decimal

diagnosis code (DX)

ICN also known as the

claim number

5 W's on balance consist of notes:

-who did I speak with


-what is the status of the claim


-when was the last action taken?


-Where is it now


-why is it there

our clearing house is

emdeon

when requesting a rebill you must fill out a

biller note

2 types of appeals (r's

reconsideration & redetermination

full line denial vs line item denial

full line denial means whole claim is denied, no payment




line item denial is partial payments from insurance, selected lines did not pay