FREE AND STUDY GAMES ABOUT CLAIMS PROCESSING

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FREE AND STUDY GAMES ABOUT CLAIMS PROCESSING

EXAM QUESTIONS

Actual Qs and Ans Expert-Verified Explanation

This Exam contains:

-Guarantee passing score -39 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation Question 1: The process of submitting medical claims electronically to an insurance carrier for reimbursement of services rendered by a health care provider

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electronic billing Question 2: Claim status indicating a claim contains complete information, but the information may be incorrect and cannot be processed by the carrier

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Invalid claim status Question 3: Private or government organizations that ensure or pay for health care on the behalf of the insured

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Third-Party Payer Question 4: Items 14-33 on the CMS-1500 used to identify the health care provider describe services performed and give the payer additional information to process the claim

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Physician/supplier information section

Question 5: Individually identifiable health information that is maintained or transmitted by health care providers

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PHI protected health information Question 6: Items 1-13 on the CMS-1500 used to identify the patient the insured the health plan and other case related data including the assignment of benefits/release of information

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Patient information section Question 7: The process health plans follow to examine claims and determine payment.

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adjudication Question 8: HIPAA standardization of electronic transactions of health care data including data elements standard code sets unique health identifiers security safeguards and privacy standards

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HIPAA electronic health care transactions and code sets Question 9: Medicaid, a joint federal and state program that helps with medical cost for some low income persons and persons and persons with disabilities allother payers must meet their financial responsibilities before Medicaid claims can be submitted

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payer of last resort Question 10: Coordinating treatment and health services between patients health care providers

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Continuity of care Question 11: The company that issues and assumes the risk of an insurance policy

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Insurance carrier

Question 12: The insured

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First party Question 13: Conformation that the patient is entitled to benefits by verifying the name of the insurance carrier the effective date of active coverage policy information group number copayments and deductible typically performed before services are rendered

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Eligibility verification Question 14: Claim status indicating the payer is waiting for information from the submitter during ajudication

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Pending claims status Question 15: Requires health care providers to establish safeguards ensuring the protection of PHI whenever transmitting any type of patient information via electronic transmission

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HIPAA Security rule Question 16: The standard claim form or uniform bill (UB) for institutional health care providers that is used throughout the U.S.

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Ub-04 Question 17: Claim form used to submit paper claims for services and procedures rendered by physicians and other health care professionals on an outpatient basis

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CMS-1500

Question 18: Claim status indicating a claim is missing required information.

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Incomplete claims status

Question 19: CMS-1500 is completed by hand and submitted for processing.

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Manual Billing Question 20: edits and routes electronic claims to the insurance carrier for payment

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clearing house Question 21: A review or formal examination of a providers accounting or a patients medical record

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Audit Question 22: Claim status indicating a claim has been processed but contained incorrect or incomplete information a claim may also be denied for medical necessity

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Denied claims status Question 23: The HIPAA privacy rule stipulates that covered entities limit the amount of information disclosed to the minimum necessary to achieve a specific goal

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minimum necessary Question 24: A secure system-to-system interchange of date in a standardized format.

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Electronic data interchange Question 25: An itemized list of provider charges generated by a hospital or by a providers office for services rendered also known as a super bill

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Patient encounter form Question 26: According to CMS is equipment that can withstand repeated use is primarily and customarily used to serve a medical purpose generally is not useful to a person in absence of illness or injury and is appropriate for use in the home is also refered t

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DME