Exam 6: Financial Management: Insurance and Billing Functions

The source document for completing the actual insurance claim form is the

The process of reviewing claims to determine payment is called

____________________ CPT codes are used to capture the face-to-face time spent between a patient and the care provider.

Groups of doctors and other healthcare providers and facilities who voluntarily form a partnership that results in high-quality, coordinated healthcare is known as a/an

Dr. Lewis's office collects patients' co-pays at the time of arrival; Dr. Mbadu's office collects the co-pay as the patient is leaving the visit. Is one method more advisable than the other? Explain your answer.

What is the name of the document typically sent by insurance companies to a subscriber detailing the services and charges submitted for payment by the medical office, the allowed amount, the co-pay satisfied by the patient, any deductible due, the amount paid by the insurance company, and the amount owed by the subscriber?

Jeannie Lopez has never been seen in Greensburg Medical Center. The evaluation and management code assigned will be based on the fact that she is a/an ___________ patient.

An insurance company submits payment to a medical practice, along with a document that details the patients and accounts for which payment is made. This document is called the

Explain why the health record is the source document for coding diagnoses and procedures.

In the Superbill Summary, shown what were the charges for the 30-minute office visit?

The amount charged for each service provided in a medical practice is known as a

A formal, written document that describes how a physician's practice or hospital ensures that rules, regulations, and standards are being adhered to is known as what kind of plan?

The charge for each service (by CPT code) provided in a medical practice is known as the fee ________________.

An electronic claims process is more efficient than a manual process. Why?

In the Superbill Summary shown, what type of visit did this patient have?

As a result of which piece of legislation are hospitals and providers reimbursed based on proof that they are rendering high-quality, coordinated care to their patients?