FEE SCHEDULE - ANSWERSA LIST OF FEES PHYSICIANS ESTABLISH AS THE FAIR PRICE FOR THE SERVICES THEY PROVIDE.
DATA ENTRY - ANSWERSUSED FOR: DEMOGRAPHIC INFORMATION, CPT, HCPCS LEVEL II, AND ICD - 10 - CM CODES TO REPORT THE SERVICES FOR THAT ENCOUNTER, PAYMENTS AND ADJUSTMENTS FROM INSURANCE CARRIE...
CPB CHAPTER 9 STUDY GUIDE
Questions & Answers
FEE SCHEDULE - ANSWERSA LIST OF FEES PHYSICIANS ESTABLISH AS THE
FAIR PRICE FOR THE SERVICES THEY PROVIDE.
DATA ENTRY - ANSWERSUSED FOR: DEMOGRAPHIC INFORMATION, CPT,
HCPCS LEVEL II, AND ICD - 10 - CM CODES TO REPORT THE SERVICES FOR
THAT ENCOUNTER, PAYMENTS AND ADJUSTMENTS FROM INSURANCE
CARRIERS
(REDUCE PAYMENT DELAY)
VERIFY INSURANCE - ANSWERSONE OF THE BEST WAYS TO AVOID PAYMENT
DELAY IS TO DO THIS
(REDUCE PAYMENT DELAY)
SUBMIT CLEAN CLAIMS - ANSWERSA CLAIM WITH ALL OF THE INFORMATION
REQUIRED TO BE PROCESSED.
(REDUCE PAYMENT DELAY)
SUBMIT CLAIMS ELECTRONICALLY - ANSWERSREDUCES CLERICAL
PAPERWORK, COST OF POSTAGE, ENVELOPES, AND FORMS. SUPPLIES THE
PRACTICE WITH REPORTS INDICATING CLAIMS WERE RECEIVED, AND EITHER
ACCEPTED OR REJECTED.
(REDUCE PAYMENT DELAY)
CHECK STATUS REPORTS - ANSWERSARE REPORTS SENT FROM THE PAYERS
IDENTIFYING THE STATUS OF THE CLAIMS THAT WERE RECEIVED. THE
REPORT WILL IDENTIFY EACH CLAIM WITH THE PATIENTS' NAMES AND DATE(S)
OF SERVICE AND WHETHER THE CLAIMS WERE ACCEPTED OR REJECTED BY
THE PAYER.
(REDUCE PAYMENT DELAY)
POST CONTRACTUAL ADJUSTMENTS - ANSWERSA CONTRACTUAL
ADJUSTMENT IS THE AMOUNT THE PROVIDER AGREES TO ACCEPT AS A
PARTICIPATING PROVIDER WITH THE INSURANCE CARRIER.
, PRIOR AUTHORIZATION - ANSWERSA REQUIREMENT THAT A PHYSICIAN
OBTAINS APPROVAL FROM A HEALTH PLAN TO PERFORM A SPECIFIC
SERVICE/PROCEDURE OR PRESCRIBE A SPECIFIC MEDICATION. WITHOUT
THIS PRIOR APPROVAL, THE HEALTH PLAN MAY NOT PROVIDE COVERAGE, OR
PAY FOR THE SERVICE/PROCEDURE OR MEDICATION.
CLAIM SCRUBBERS - ANSWERSA SOFTWARE PROGRAM THAT REVIEWS
CLAIMS FOR KEY COMPONENTS BEFORE THE CLAIMS ARE SENT TO AN
INSURANCE COMPANY. WILL IDENTIFY POSSIBLE ERRORS BEFORE THE CLAIM
IS SUBMITTED.
ACCOUNTS RECEIVABLE OR A/R - ANSWERSMONEY OWED TO THE PRACTICE
FOR SERVICES RENDERED AND BILLED. PAYMENTS DUE FROM PATIENTS,
PAYERS, OR OTHER GUARANTORS
DAILY DEPOSITS - ANSWERSWHEN PATIENTS ARE SEEN IN THE OFFICE,
COPAYMENTS, DEDUCTIBLES, COINSURANCE, OR PATIENT BALANCES MAY BE
COLLECTED BY THE OFFICE STAFF. PATIENT PAYMENTS WILL ALSO COME
INTO THE OFFICE BY MAIL, ALONG WITH PAYMENTS FROM INSURANCE
COMPANIES WHERE DIRECT DEPOSIT IS NOT AN OPTION.
DIRECT DEPOSITS - ANSWERSMANY OF THE INSURANCE PAYERS WILL PAY
CLAIMS WITH DIRECT DEPOSIT. ONCE THE ADJUDICATION PROCESS HAS
BEEN FINALIZED, THE PAYER WILL SEND THE REMITTANCE ADVICE (RA) TO
THE PROVIDER AND AN EXPLANATION OF BENEFITS (EOB) TO THE PATIENT.
ELECTRONIC CLAIMS - ANSWERSCAN BE SUBMITTED TO A CARRIER FROM A
PROVIDER'S OFFICE USING A COMPUTER WITH SOFTWARE THAT MEETS
ELECTRONIC FILING REQUIREMENTS AS ESTABLISHED BY HIPAA CLAIM
STANDARDS.
DSL (DIGITAL SUBSCRIBER LINE) - ANSWERSA VERY HIGH SPEED
CONNECTION THAT USES THE SAME WIRES AS A REGULAR TELEPHONE LINE.
PROVIDERS INSTALL SOFTWARE ON THEIR COMPUTER TO USE A DSL
SERVICE.
EXTRANET - ANSWERSA 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.
INTERNET - ANSWERSA VAST COMPUTER NETWORK LINKING SMALLER
COMPUTER NETWORKS WORLDWIDE. USING THE INTERNET ALLOWS
PROVIDERS SECURE TRANSMISSION OF CLAIMS WITHOUT THE NEED FOR
ADDITIONAL SOFTWARE.
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