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MASTERY EXAM
22 cards·by sammizee
The insurance specialist is responsible for?
Correcting claims and processing errors
To make sure you're speaking to correct patient you?
ask the patients name, DOB, and Insurance ID #
What is necessary to complete a CMS 1500
Cpt Codes, Demographics, Diagnosis Code, Signiture on File, Physicians info
what is another word for a follow up?
Adjudication
what is the legal definition for adjudication
a process in which final determination is made for an appeals board
how will insurance reception know who to follow up on?
Aging Report
Authorization to release information?
Box 12 Allows release of information
what is box 13 on CMS 1500?
Assignment of Benefits signiture allows release of information
what is the definition of professionalism
conduct and qualities that a person posses
when is the best time to collect any fees a patient owes
At the time of service (collect any fees at the time of service)
when is the appropriate time to discuss fees with a patient?
Do you have any questions about the cost of todays visit?
What do you do when a patients insurance is canceled?
ask them if they have another insurance carrier
what is commercial insurance?
Third Party Insurance Carriers
when should patient sign ABN?
Prior to service
what is health insurance specialist not allowed to do?
accuratly diagnosis patient with medical necessity
Day sheet transforms all transactions to
Patient Ledger
posting payments and dont agree is because
payments have been misplaced
when posting payments to patients acct. what do you need to allocate pts record?
need date of service, patients name and cpt codes
when calling insurance carrier why claim is denied you ask for?
date claim was denied, date of service, and insurance ID #
if the provider gives an adjustment (Curtisy award) to patient you find that where?
in the adjustment column
staute of limitaions is
the maximum time that a debt can be collected from the time it was encurred
when you take credit card from patient what is three things you need?
credit card#, security code, account #