Billing / Coding 3 Flashcards
The practice’s rules for payment for medical services are found in their
financial policy.
Which of these documents will the patient not complete?
encounter form
Identify the person/entity that must authorize providers to release a patient’s PHI for TPO purposes.
none of these; they do not need authorization
You are working at a practice and have been asked to document some payer communications. Determine where the communications should be recorded.
financial record
Determine by which of the following means a practice may receive a “self-refer.”
the patient comes for specialty care without a referral number when one is required
What provision explains how insurance policies will pay if more than one policy applies?
coordination of benefits
Determine what you should ask the patient to do upon arrival.
Complete all required forms before their first encounter with the provider.
Another term for prior authorization number is
certification number.
What type of number is assigned to a HIPAA 270 electronic transaction?
trace number
Sometimes the use of a third payer is necessary after two health plans have made payments on a claim. This type of insurance is known as
tertiary insurance.
What type of provider is required to have patients sign an acknowledgment?
direct provider
Which HIPAA transaction is used to send information from a primary payer to a secondary payer?
Coordination of Benefits
You are working at a practice and need to get prior approval from a payer. Which of the following HIPAA transactions would you use to do so?
Referral Certification and Authorization
Identify the best time during which to begin collecting patient information.
preregistration process
The initial step in establishing financial responsibility is to
Verify the patient’s eligibility for insurance benefits.
When a provider asks a health plan for approval of a service, the response is known as the
X12 278.
What Medicare form is used to show charges to patients for potentially non-covered services?
Advance Beneficiary Notice
Patients who elect to pay a higher copayment, greater coinsurance, or both, are most likely visiting a
nonPAR.
What is another name for the HIPAA Eligibility for a Health Plan transaction?
X12 270/271
If a patient authorizes a provider to accept assignment, what can the provider now do on their behalf?
File claims for the patient and receive payments directly from the payer.
Assignment of benefits authorizes
the physician to file claims for a patient and receive direct payments from the payer.
What information does RTA allow the practice to view?
the amount the health plan will pay and amount patient will owe
What are the procedures that ensure billable services are recorded and reported for payment called?
charge capture
Eligibility for government-sponsored plans where income is the criterion may change as quickly as
monthly.
