Test

Front 1

Bill type 111

Back 1

Inpatient Original

Front 2

Bill type 117

Back 2

Inpatient Corrected Claim

Front 3

Bill type 118

Back 3

Inpatient Void Claim

Front 4

Bill type 131

Back 4

outpatient original claim

Front 5

Bill type 137

Back 5

outpatient corrected claim

Front 6

Bill type 138

Back 6

outpatient void claim

Front 7

PR-1 Is the non-medical code for

Back 7

deductible

Front 8

Pr-2 is the non-medical code for

Back 8

coins

Front 9

PR-3 is

Back 9

co-payment

Front 10

Which insurance is the payer of the last resort?

Back 10

Medicaid (always last)

Front 11

TOB can be found in which FL?

Back 11

field locator 04

Front 12

RA/835 is distributed to..

Back 12

the provider

Front 13

ABN

Back 13

advanced beneficiary notice(medicare patients)

Front 14

CO remark code stands for

Back 14

contractual obligation (non-medical group code)

Front 15

MSP

Back 15

medicare secondary payer

Front 16

DRG

Back 16

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

Front 17

HCFA claim form is for ___

Back 17

hospital claims

Front 18

UB-04

Back 18

uniform bill

Front 19

NPI (10 digits)

Back 19

national provider identifier

Front 20

UB-04 does not require revenue code

Back 20

false, those codes are 960-999

Front 21

The allowed amount is the maximum allowed amount that

Back 21

the insurance pays to the provider

Front 22

TOB

Back 22

type of bill

Front 23

APC

Back 23

ambulatory payment classification (outpatient)

Front 24

HMO

Back 24

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

Front 25

PPO

Back 25

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

Front 26

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

Back 26

coins

Front 27

Cash App Form

Back 27

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

Front 28

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

Back 28

non-medical

Front 29

PR26

Back 29

expenses occurred before coverage

Front 30

PR96

Back 30

non-covered charges

Front 31

PHI

Back 31

protected health information

Front 32

When calling insurance what are your 3 bullet points

Back 32

-know why you're calling

-know relevant info

-use other accounts

Front 33

DCN

Back 33

form to use when correcting a claim

Front 34

HSA

Back 34

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

Front 35

FSA

Back 35

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.

Front 36

Medicare if for those 65 & older or

Back 36

disabled.

part a- mandatory

part b- outpatient care

part c- prescription drugs

part d- covers prescription drugs coverage

Front 37

Workers comp required if over ___ employees

Back 37

5

Front 38

FCR (First Call Resolution)

Back 38

-first call last call

-what is preventing payment?

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

-have all my questions been answered?

Front 39

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

Back 39

-why you're calling

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

-reason for calling

-additional accouts

Front 40

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

Back 40

the check/eft number

Front 41

HIPPA

Back 41

healthcare insurance portability and accountability act

Front 42

Resq status code 0000

Back 42

new work

Front 43

Resq status code 0001

Back 43

returned work

Front 44

Resq satus code 5101

Back 44

coding issues pending review

Front 45

Resq status code 8803

Back 45

zero balance

Front 46

NCOF

Back 46

no claim on file

Front 47

Account balances will either be (5 things)

Back 47

-payments

-contractual adjustment

-denied charge

-PR

-unfiled/late charge

Front 48

The claim number is signed to a specific

Back 48

dos

Front 49

9999999IN is an example of what

Back 49

a medicare patient on a eob

Front 50

RA's are sent from the ___ to the ____

Back 50

insurance to the provider

Front 51

Medical & non-medical codes can be fund on a

Back 51

RA & EOB

Front 52

Imaging systems hold EOBs not

Back 52

patient accounting systems

Front 53

Ancillary charge (tob)

Back 53

121

Front 54

skilled nursing facilities (SNF) are

Back 54

hospices

Front 55

DDE

Back 55

database for medicare claims

Front 56

APC

Back 56

ambulatory payment classification. how a claim is paid

Front 57

NDC

Back 57

national drug code. info such as milligrams & quantity.

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

Front 58

Doctors send ____ to the insurance

Back 58

UB-04's

Front 59

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

Back 59

professional billing

Front 60

To find the contractual adjustment on an eob subtract the

Back 60

allowed amount from the billed amount

Front 61

modifiers are the 2 digits after a

Back 61

hcpcs code

Front 62

DPD

Back 62

detailed procedure document

Front 63

3-5 digits with a decimal

Back 63

diagnosis code (DX)

Front 64

ICN also known as the

Back 64

claim number

Front 65

5 W's on balance consist of notes:

Back 65

-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

Front 66

our clearing house is

Back 66

emdeon

Front 67

when requesting a rebill you must fill out a

Back 67

biller note

Front 68

2 types of appeals (r's

Back 68

reconsideration & redetermination

Front 69

full line denial vs line item denial

Back 69

full line denial means whole claim is denied, no payment

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