What type of audit do payers routinely conduct to ensure that claims are compliant with the provisions of their contracts?
Post payment
Under HIPAA may not?
Refuse to accept the standard transactions
Name a function of the carrier block?
It allows for four-line address for the payer
Recovery audit contractors request for info must be answered in how many days?
45
if medicare is the secondary payer the claim must be submitted using the?
HIPAA837P
what are complications caused by avoidable conditions that will not be reimbursed?
Never events
the electronic transmission of claims is not required by law if a practice never sends any kind of electronic health care transactions and has less then how many full time or equivalent employees?
Ten
CMS out into place the requirement for what indicator for every reported diagnosis code for a patient?
POA
A patients other conditions at admission that affect care during the hospital being coded are called what meaning coexisting conditions ?
Comorbidities
Where is the carrier block located on the CMS-1500?
Upper right
which law requires disclosure of finance charges and late fees for payment plans?
Truth lending act
The type of patient billing that spreads out the workload of mailing statements is called?
Cycle Billing
In hospital coding and reporting what is true?
The principle procedure is often a surgical procedure
What HIPAA transactions is used by the medical officws to ask payers about the status of submitted claims?
276
UHDDS is the abbreviation for?
Uniform hospital discharge data set
which of the following is not considered to be a common error in generating claims?
Missing patient names
The person filing an appeal is known as what regardless of whether that individual is a provider or a patient?
Either the claimant or the appellant
What organization determines the content of both HIPAA 837 and CMS-1500 claims?
NUCC
What refers to a coding problem in which the age of the patient and the selected code do not match?
Incorrect coding
The payer sends the medical practice ?
an RA that covers a batch of processed claims
Inpatients are admitted to hospitals in a process called ?
Registration
what refers to the payers review and reduction of a procedure code?
Downcoding
when a RA is received the medical insurance specialist ?
Checks the mount paid matches the expected payments
Claims that are acceptable for adjudication by payers are called?
clean claims
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