Exam 31: Preparing Insurance Claims and Posting Insurance Payments

Match each type of information found on an Explanation of Benefits (EOB)form with its definition. -Beginning and end dates of the health-related service a patient received from a provider

Match each term with its definition. -Book in which a list of insurance claims is kept

​Match the type of insurance to its description.Note: Answers may be used more than once. -​A network of providers and hospitals that are joined together to contract with insurance companies,employers,or other organizations to provide health care to subscribers and their families for a discounted fee

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -​Billing for services,supplies,or equipment that were not medically necessary or not provided

Match each term with its definition. -Use of these allows a medical facility or provider's office to submit transactions faster and be paid sooner

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -​Without intent

The steps to file a third-party claim and accurately complete the CMS-1500 form include:

​Match the type of insurance to its description.Note: Answers may be used more than once. -​A group insurance that entitles members to services provided by participating hospitals,clinics,and providers

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -​Have a "claim scrubber" program that will scrub the claim before it is sent to payers

​The process of billing a secondary insurance company involves which of the following?

​Match the type of insurance to its description.Note: Answers may be used more than once. -If a patient receives health care from a network provider,he or she would usually not need to file a claim

​Match the type of insurance to its description.Note: Answers may be used more than once. -​If the patient receives out-of-network services,he may have to pay the provider in full and then file a claim with the insurance to get reimbursed

Match each term with its definition. -Sets forth the very specific requirements a provider must meet in order to submit paper claim forms and receive CMS payment

​Match the type of insurance to its description.Note: Answers may be used more than once. -​Patients do not have to file a claim,and the provider may not charge a patient directly or send a bill

Match each type of information found on an Explanation of Benefits (EOB)form with its definition. -Code and brief description of the health-related service a patient received from a provider

When applying an insurance adjustment to a patient's account,you are not typically required to post the:

​Information required to post on the patient account includes all of the following except:

When following up on a delinquent claim,if the carrier tells you that it is still in process,you should:

​A private or public company that often serves as the middleman between providers and billing groups,payers,and other health care partners for the transmission and translation of electronic claims information into the specific format required by payers is known as:

Match each term with its definition. -Patient's signature on a form that permits the release of his or her information,allowing the claim to be filed on his or her behalf