Exam 15: Keys to Successful Claims Management

A nine-digit number required by businesses to serve as their taxpayer identifying number is the:

The basic responsibility of the National Correct Coding Initiative is to generate:

If patients are covered by two insurance plans,the health insurance professional may have to submit a primary claim and a _____ claim.

The book outlines 12 keys to successful claims processing.

Documenting the appropriate medical information in the patient's health record is the responsibility of the:

Explain how the Health Care Claim Status Inquiry/Response system works.

An alternative to the suspension file is to record claims information on a columnar form called a/an:

What is the first key to successful claims processing?

There are five different levels of the Medicare appeals process.

How frequently claims are submitted can vary depending on:

Participating providers can balance bill,but nonparticipating providers for commercial claims are not allowed to.

While coordination of benefits (COB)does not occur as often as it once did,it is still an occasional occurrence.What two things should a health insurance professional do when this situation arises?

Real Time Claims Adjudication (RTCA)allows instant adjudication of an insurance claim.

HIPAA has developed a transaction that allows payers to request additional information to support claims.

Medicare secondary payer claims are claims that are submitted to another insurance company after they are submitted to Medicare.

What information can usually be deduced from an explanation of benefits (EOB)or remittance advice (RA)? Include at least five examples in your answer.

The key to knowing how much of the claim was paid,how much was not,and why is the:

The claims process actually starts with the patient's appointment.

Verifying a patient's healthcare coverage is an important duty of a health insurance professional.

Adjudication is the process by which: