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Flashcards in Chapter 4 Deck (20):
1

Define guarantor

The person who is ultimately responsible for payment to the medical office

2

Define Assignments of Benefits Form

Patient wishes insurance payments to be made directly to the provider

3

Define release of information form

A claim can only be submitted to an insurance carrier on the patient's behalf

4

How often should the medical office request that the patient sign and update a release of information form?

Once a year

5

Define clearinghouse

A company that receives a claim from providers, audits tehm, and forwards them on to insurance carriers

6

What is listed on an Audit-Edit report form a clearinghouse?

Claims that need corrections, claims that are missing information, claims forwarded to the insurance carrier

7

Define encryption

Scrambling electronic information during transmission to prevent it from being intercepted by unauthorized users

8

Pertaining to the CMS 1500 form, what does the acronym OCR refer to?

optical character recognition

9

Who issues the Employer Identification number or federal tax ID number?

IRS

10

What is the identification number issued to physicians who are authorized to practice medicine in a given state?

State license number

11

Define dirty claim

Information is missing from a claim when it is submitted to an insurance carrier

12

Explain the birthday rule

The parents whose date of birth is earliest in the year

13

When will the coordination of benefits be used

The determination of how claims will be paid by each insurance plan

14

Define supplemental insurance

A limited insurance policy purchased to cover part of the patient's expenses, for which the patient would be otherwise responsible

15

Who developed the cms-1500 claim form

The centers for medicare and medicaid

16

What is the subsection of HIPPA that regulates electronic billing

Administrative Simplification

17

Who are covered entities according to HIPPA?

Health plans, clearinghouses, billing services, and providers

18

On the CMS-1500 claim form what does EMG mean?

Emergency services

19

On the CSM-1500 claim form what does NPI stand for?

National Provider Identifier

20

On the CSM-1500 claim form what does EIN stand for?

Employer Identification Number