mop130 week 3

The claim is also checked against the __________, which is an abstract of all recent claims filed on each patient and helps determine whether the patient is receiving concurrent care for the same condition by more than one provider.

Medicare calls its remittance advice a(n) __________.

When a Medicare claim is appealed, the final, fifth level of the appeal process is the _________________

Any procedure or service reported on the claim that is not included on the master benefit list is a noncovered benefit and will result in claims ___

APCs are used to calculate reimbursement for:

A delinquent account is also called a __________ account, which means it is one that has not been paid within a certain time frame (e.g., 120 days). Following up on such delinquent accounts is crucial to the success of the business.

If a claim is denied for "another insurance is primary," what action should be taken by the provider's office?

When a claim is denied for procedure/service not medically necessary, what would be the first steps the provider's office should take?

A claims attachment is __________ documentation associated with a health care claim or patient encounter.

A pre-existing condition is any medical condition that was diagnosed and/or treated within a specified period of time__________ the enrollee's effective date of coverage.

What is the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the insurance company is obligated to pay any benefits?

One reason to track unpaid claims is due to the payment error in which a patient erroneously cashes a check made out to both patient and provider, which is called a __

When incorrect codes are submitted on a claim that leads to denial, the provider's office should _________________

Which is the term for the reason for a denied or rejected claim as reported on the remittance advice or explanation of benefits?

The OPPS calculates reimbursements using which of the following?

Coordination of benefits (COB) is a provision in __________ health insurance policies intended to keep multiple insurers from paying benefits covered by other policies.

The IPPS is a system by which Medicare reimburses hospitals for inpatient hospital services based on:

Covered entities are required to use mandated national standards when conducting any of the defined transactions covered under HIPAA. Which is an example of a covered entity

Medicare appeals are now referred to as _____

Which prohibits discrimination on the basis of race, color, religion, national origin, sex, marital status, age, receipt of public assistance, or good-faith exercise of any rights under the Consumer Credit Protection Act?

The OPPS calculates reimbursements using which of the following?

The term "per diem" in healthcare primarily refers to:

What is the main purpose of diagnosis-related groups (DRGs) in healthcare reimbursement?

What is the electronic or manual transmission of claims data to payers or clearinghouses for processing?

Which requires providers to make certain written disclosures concerning all finance charges and related aspects of credit transactions (including disclosing finance charges expressed as an annual percentage rate)?