CPB Chapter 9 - Billing Questions And Answers With Verified Solutions Graded A+
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CPB Chapter 9 - Billing
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CPB Chapter 9 - Billing
________ is when the provider has limited access to payer and patient data elements on their patients
only. - Extranet
An extranet is a private computer network allowing controlled access to the payer's system. The provider
has limited access to payer and patient data elements on their patients ...
CPB Chapter 9 - Billing ________ is when the provider has limited access to payer and patient data elements on their patients only. - Extranet An extranet is a private computer network allowing controlled access to the payer's system. The provider has limited access to payer and patient data elements on their patients only. 1992 US federal government implemented a standardized physician payment schedule utilizing resource -
based relative value scale - RBRVS A batch of claims is submitted to the clearinghouse for processing. The status report shows that 20 claims were acknowledged and forwarded on to the payer for payment and 10 claims were rejected. What is the next step the medical biller should take in this situation? - Review the status report to identify the reasons for rejection, make needed corrections and resubmit for payment. When a claim is rejected at the clearinghouse level, the medical biller must review the reason for the rejection and verify the information in the practice management system, correct if needed and rebill the claim. A claim submitted with all the information necessary to process the claim is considered? - clean claim. Clean claim submitted with all the necessary information to process or adjudicate the claim. Each payer will identify the elements required to be a clean claim. A claim with no errors - Clean claim A clearinghouse is an entity that provides the following services: - Processes or facilitates the processing of claims for providers and healthcare plans. Clearinghouses convert nonstandard data received from payers to standard transaction data to meet HIPAA requirements. Other services, claims status tracking, insurance eligibility determination, and secondary billing services A clearinghouse is an entity that provides which following service? - Converts nonstandard data received from payers to standard transaction data to meet HIPAA requirements. A family has health insurance coverage from both father and mother. Fathers b -day is May 28, 1989 and mother b -day is May 26, 1990. Which insurance would be primary? - mother. The mother's birthday is May 26 and the father's is May 29. The birthday rule is based on month and day of birth not the year of birth. A fee schedule can be based on - Relative Value Units (RVU) A hospital chargemaster contains the following? - Department code (indicates where service was performed) Service code (internally identifies specific service performed) Service Description (narrative description of supply, service or procedure) CPT® Code Revenue code (four digit code assigned to each supply, service or procedure) Relative Value Units (RVUs) Charge amount A hospital chargemaster does NOT contain which of the following? - ICD-10-CM diagnosis code A hospital -specific electronic list that includes all hospital procedures, services, supplies, and drugs that are billed to payers. Synonymous with charge description master (CDM) - Chargemaster A list of fees the physician establishes is the fair price for the services they provide - Fee schedule A patient with ABC insurance is seen on May 1, and the claim is submitted on July 15 of the same year. Has the claim met the timely filing deadline? - Maybe. ABC's timely filing policy should be reviewed to determine if the deadline was met. Each payer will have a policy stating their timely filing requirements. The payer's policy should be researched and applied accordingly A physician writes an order for his patient to be admitted to the hospital for observation for suspected dehydration. The patient is observed for 8 hours and discharged to home following hydration therapy. This patient is considered to be - outpaitient. Even though the physician ordered the patient to be admitted to the hospital, the patient did not stay longer than 24 hours. Based on this criteria, the services should be billed as facility outpatient. A requirement that a physician obtain approval from a health plan to receive a specific procedure or prescribe a specific medication - Prior authorization A review and evaluation of healthcare procedures and documentation for the purpose of comparing the quality of services provided in a given situation - Audit A software program that reviews claims for key components before the claims are presented to an insurance company - Claim scrubber A(n) ____________ is a listing of every single procedure that a hospital can provide to its patients that are billed to payers. - Chargemaster. A hospital charge description master (CDM), also called a chargemaster, is a master price list of all services, supplies, devices, and medications charged for inpatient or outpatient services by a healthcare facility. It is similar to a charg e ticket in the medical office, but much more extensive. Accounts Receivables (A/R) - patients, payers, other guarantors - Daily Deposits can be: - co-payments - deductibles - co-insurance - patient balances - patient mail in payments Daily deposits must be balance each day (amount posted in practice management system (PMS). This must match deposit amount for the batch Direct Deposits - should match remittance advice (RA) sent to the provider from the insurance carrier. Balance the posted amount from the RA to the check, they must match
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