Mindtap MA Ch 30 Test Yourself

Providers have been urged to send claims electronically since:

2005.

Misusing codes on a claim, such as upcoding or unbundling codes, is an example of:

Medicare fraud and abuse.

Prior to sending any claims to a third party for reimbursement, you should be certain that you have a copy of the patient's:

insurance card.

A bill for secondary insurance coverage would be created:

after the payment is received from the primary insurer.

A provider can charge more than the Medicare-approved amount, but there is a limit called ____ which is up to 15 percent over the amount that nonparticipating providers are paid.

"the limiting charge"

The amount of a non-covered service, the deductible, or out-of pocket requirements is noted on the EOB as:

not allowed amount.

It is recommended that a patient's signature on file be updated:

annually.

A ____ is a claim that is automatically forwarded from Medicare to a secondary insurer after Medicare has paid its portion of a service in the EHR.

"crossover claim"

Which of these is the standard claim form used for billing in medical offices?

CMS-1500

A ____ is a book in which a list of insurance claims is kept.

"manual insurance log"

Whose Social Security number is used as the insurance plan ID number?

Policy holder

If a doctor, provider, or supplier doesn't accept assignment of Medicare insurance, they are referred to as ____ providers.

"nonparticipatinh"

A(n) ____ must be in place in order to file a claim electronically.

"Electronic Data Interchange (EDI)"

If a patient is a member of a health insurance plan operated by a payer that supports ____ , the medical assistant would log into the payer's website and enter the information on the visit. Upon electronic receipt of the information, the payer's system calculates the payment to the provider and the amount owed by the patient, and displays on the medical assistant's screen.

"real time adjudication"

In some cases, the patient might have to submit his or her own claim to Medicare, using Form ____ in order to receive reimbursement for the costs.

CMS-1490S

____ means that the doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services.

Medicare Assignment

An insurance adjustment is the difference in amount from what the provider charged and:

the contracted amount with a particular insurance company.

When applying an insurance payment to a patient account on a computerized system, you are not required to post the:

amount owed by the patient.