Chapter 26

If the ICD-10 codes and the CPT codes do not match the claim will lack

Person legally responsible for the entire bill

How many blocks does the CMS 1500 have

A set dollar amount that the policy holder must pay before the insurance company starts to pay for services

It is important to show ______ when discussing financial responsibilities with the patient

Software that finds common billing errors before claim is sent to insurance company

NPI stands for

Claims with incorrect or missing data is called

Reformats data to meet the specifications outlined by the insurance plan and then submits the claim

A payment arrangement for healthcare providers

Service code used for a doctors office

Claim submitted to the wrong insurance company will be

Fixed amount per visit and due at the time of each appointment

A CMS 1500 is what type of form

Requirements to participate in the healthcare plan

Section 2 of CMS 1500 contains information of

To knowingly or willfully execute a scheme

Copy/Scan the front & back of the patients insurance card at first initial visit

CPT codes are used for

EOB stands for

To examine claims for completeness and accuracy before submission

ICD-10 is used for

Your PCP must send out a _____ to see a specialist

The first section that indicates the type of plan to which the claim is being submitted is the

PCMH stands for

Always document precertification number into the patients chart

Rule used to determine which policy is primary and which is secondary

1 reason a claim can be denied is due to technical errors