Medical Billing and Coding Chapter 7 Flashcards
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| 14060451515 | CMS 100 - | paper claim submitted to TPP for reinbursement ( paper claim ) | 0 | |
| 14060451516 | HIPPA x12 837 - | electronic form used to send a claim ( HIPPA 837 P claim (electronic) | 1 | |
| 14060451517 | HIPPA requires electronic transmission of claims by all providers with _________ employees. | 10 or more | 2 | |
| 14060451518 | National Uniform Claim Commitee (NUCC) - | organization responsible for claim content | 3 | |
| 14060451519 | CMS - 1500 (02/12) -revised- | current paper claim approved by the NUCC | 4 | |
| 14060451520 | 5010 version - | new format for the EDI transactions (data exchange electronic) | 5 | |
| 14060451521 | The CMS - 1500 claim has a _________________________________ and _____ item numbers (INs) | carrier block and 33 item numbers | 6 | |
| 14060451522 | Carrier Block - | data entry area in the upper right of the CMS - 1500 | 7 | |
| 14060451523 | Condition code - | two digit numeric or alphanumeric codes used to report a special condition or unique circumstance. | 8 | |
| 14060451524 | The upper portion of the CMS - 1500 claim form ( ITEM Numbers 1-13) : | lists demographic information about the patient and specific information about the patients insurance coverage. | 9 | |
| 14060451525 | Insurance is entered based on | the patient information form, insurance card, and payer verification . | 10 | |
| 14060451526 | Types of providers (4) | 1. pay to provide 2. rendering provider 3. Billing provider 4. referring provider | 11 | |
| 14060451527 | Pay to provider - | person or organization that will be paid for services on a HIPPA claim | 12 | |
| 14060451528 | Rendering provider - | term used to identify an alternative physician or professional who provides the procedure . | 13 | |
| 14060451529 | Billing provider - | person or organization sending a hippa claim | 14 | |
| 14060451530 | Physician / Supplier information section ( CMS 1500 ) - | this section identifies the healthcare provider, describes the services performed and gives the payer additional info to process the claim | 15 | |
| 14060451531 | Other ID number ( CMS 1500 ) - | additional provider identification number | 16 | |
| 14060451532 | Qualifier ( CMS 1500 ) - | two digit code for a type of provider identification number other that the NPI | 17 | |
| 14060451533 | Outside laboratory (CMS 1500 ) - | purchased laboratory services . | 18 | |
| 14060451534 | Service line information ( CMS 1500) | information about services being reported | 19 | |
| 14060451535 | Place of Service ( POS ) code (CMS 1500 ) - | (24. B ) administrative code indicating where medical services were provided | 20 | |
| 14060451536 | Taxonomy Code (CMS 1500) - | administrative code set used to report a physicians specialty | 21 | |
| 14060451537 | administrative code set (CMS 1500 ) - | required codes for various data elements. | 22 | |
| 14060451538 | The lower portion of the CMS 1500 claim form ( item numbers 14-33 ) : | contains information about the provider or supplies and the patients condition, including the diagnosis, procedures, and charges (information is based on the encounter form ) | 23 | |
| 14060451539 | Data element ( 837 claim ) | smallest unit of information in a HIPPA transaction . Example : A patients name | 24 | |
| 14060451540 | Required data element ( 837 claim ) | information that must be supplied on an electronic claim | 25 | |
| 14060451541 | Situational data element - | information that mst be on a claim in conjunction with certain other data elements. | 26 | |
| 14060451542 | 5 sections of the HIPPA 837 claim : | Provider information subscriber information payer information claim information service line information | 27 | |
| 14060451543 | Responsible party ( 837P claim ) | other person or entity who will pay a patients charges | 28 | |
| 14060451544 | claim filing indicator code (837P ) - | administrative code that identifies the type of health plan | 29 | |
| 14060451545 | individual relationship code (837P) - | administrative code specifying the patients relationship to the subscriber | 30 | |
| 14060451546 | destination payer (837P ) | health plan receiving a HIPPA claim | 31 | |
| 14060451547 | Claim control number (837P) | unique number assigned to a claim by the sender | 32 | |
| 14060451548 | Claim frequency code or claim submission reason code (837p) | adminisytrative code that identifies the claim as original , replacement, or void/ cancel action | 33 | |
| 14060451549 | line item control number | unique number assigned to each service line item reported q | 34 | |
| 14060451550 | claim attachment - | additional data in printed or electronic format sent to support a claim . Examples : include lab results , specialty consultation notes, and discharge notes. | 35 | |
| 14060451551 | Clean claim - | claim accepted by a health plan for adjudication. properly completed and contains all the necessary information . | 36 | |
| 14060451552 | HIPPA x12 276/277 Health care claim status Inquiry / Response | electronic format used to ask payers about claims . | 37 | |
| 14060451553 | 277 - | response | 38 | |
| 14060451554 | 276 - | inquiry | 39 | |
| 14060451555 | Claim scrubber - | soft ware that checks claims to permit error correction | 40 | |
| 14060451556 | Transmission of electronic claims through three major methods ; | 1. in the direct transmission approach , providers and payers exchange transactions directly 2. The majority of providers use clearinghouses to send and receive data incorrect EDI format 3. Some payers offer online direct data entry (DDE) to providers, which involves using an Internet- based service into which employees key the standard data elements | 41 |
