The patient owes $25.00 for the visit. The amount collected for the office visit is called what? - ✔✔Copayment The insurance carrier rate is 80% the remaining 20% is called what? - ✔✔Coinsurance A third party payer made an error when adjudicating a claim which of the following should the specialist do? - ✔✔resubmit the claim with an attachment explaining the error A claim submitted with all the necessary and accurate information so that it can be processed and paid is called? - ✔✔A clean claim A medicare patient presents to an out patient hospital facility for a hysterectomy. To which medicare plan should be billed? - ✔✔Part B The amount of the bill is $100 and this amount must be paid before the insurance company will pay on the claim. Which of the following is this called? - ✔✔Deductible When there is a professional courtesy awarded to a patient's account the insurance specialist should post the amount under what column? - ✔✔Adjustment column When the patient calls to inquire about an account which of the following does the insurance and coding specialist need to ask for before discussing the account? Choose 3 correct answers. - ✔✔patient's insurance Id number, patient's date of birth, patient's name When a capitation account is applied to a ledger it is also know as what? - ✔✔Monthly Prepayment amount The insurance and coding specialist calls a carrier to verify a patient's insurance an the representative states that the patient's insurance was cancelled three months ago. Which of the following should the insurance specialist do first? - ✔✔Ask the patient for another form of insurance coverage Which are the following are necessary to complete a CMS-1500 form (Choose 3) correct answers. - ✔✔Diagnosis CPT and ICD-10 codes, Physician information, Demographic information Which of the following reports is used to follow up on an outstanding claims to third party payers? - ✔✔Aging When following upon a denied claim an insurance specialist should have which of the following information available when speaking with the insurance company? Select 3 correct answers. - ✔✔Patient's insurance ID number, Physician's NPI number, and Date of service Developing an insurance claim begins when? - ✔✔When the patient calls to schedule an appointment Which of the following must be verified to process a credit card transaction? Choose (3) correct answers. - ✔✔Security code, credit card number, and account number The most effective method to manage statements and other financial invoices as well as avoid payment delays is to do what? - ✔✔Collect fees at the time of service Based on the CMS 1500 manual system, when updating or maintaining the billing code database which of the following does the R denote? - ✔✔Revised An insurance and coding specialist is reviewing a patient's encounter form that is documented in the medical record prior to completing a CMS-1500 form she notices the physician up-coded the encounter form. The specialist has an ethical obligation to first? - ✔✔Query the physician HIPPA allows a healthcare provider to communicate with a patient's family, friend, or other person's who are involved in the patient's care regarding their mental health status providing the patient does what? - ✔✔Does not object Claims are often rejected because a provider needs to obtain what? - ✔✔Preauthourizations