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HCCA CHC - Enterprise Wide Billing and Reimbursement Questions and Answers with complete solutions $7.99   Add to cart

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HCCA CHC - Enterprise Wide Billing and Reimbursement Questions and Answers with complete solutions

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  • HCCA CHC - Enterprise Wide Billing And Reimburseme

Medicare - Part C Insurance (Medicare Advantage) - Government managed care. Must be paying Part B Premiums to qualify. Def: Medicare Code Editor - As san electronic claim is being processed, it goes through the editor for accuracy. CMS 1500 Paper Billing Form/837P Electronic Billing Form - Used...

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  • August 22, 2024
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  • 2024/2025
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  • Questions & answers
  • HCCA CHC - Enterprise Wide Billing and Reimburseme
  • HCCA CHC - Enterprise Wide Billing and Reimburseme
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ACADEMICMATERIALS
HCCA CHC - Enterprise Wide Billing and
Reimbursement
Medicare - Part C Insurance (Medicare Advantage) - Government managed care. Must be paying
Part B Premiums to qualify.



Def: Medicare Code Editor - As san electronic claim is being processed, it goes through the editor
for accuracy.



CMS 1500 Paper Billing Form/837P Electronic Billing Form - Used by Physicians to bill



Def: Carrier - Part B, administers MD claims



Def: Certificate of Medical Necessity - MD certification that service is necessary



Def: CMS Allowable - Amount/maximum CMS allows for payment



Def: Common Working File (CWF) - There are 9 across the USA; house all patient data and claims
history.



Def: Coordination of Benefits - Determining in what order a claim will be paid



Def: Electronic Data Interchange (EDI) - Standards by which claims are transmitted



Def: Fiscal Intermediary (FI) - Process for Medicare Part A



Def: Grouper - Group codes for DRGs (diagnosis related groups)

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