Chapter 6 of NHA study guide

Rewards the provider with incentive payments for meeting defined program performance standards.

If the patient has a copay, is it best for the practice to collect it at the time of the encounter?

Percentage of the allowed amount, for example the insurance pays 80% so the patient pays 20%

When the managed care organization agrees to a set reimbursement amount per patient, per month.

explains any adjustment made to payment and gives patients responsibility for deductibles, copay or coinsurance amount

Health insurance plans offered by commercial companies

Can dispute payer's decision when an health care organization does not agree with a reason for reduced or denied payment

 The process of entering codes associated with the patient encounter to prepare the claim for submission.

Clean claims pass the software edit system without any data entry or coding errors

Which of the following is used to report outpatient and professional services to the third-party payer?

Aging reports do not identify which patients have past due accounts

 Insurance plans that are further classified as federal or state programs.

 Patient aging reports can be sorted and categorized by showing the current balance of how many days?

Process by which the insurance carrier reviews the benefits and coverage and then either processes or denies the claim

List of outstanding account balances, either patient balance or insurance payer balances.

A patient goes to an office and pays the set amount for the office visit of 30 dollars. What kind of payment is this?

Outpatient hospital charges, Primary and secondary care, Ambulatory care

The part that handles prescription medication in medicare

An organization that accepts claim data from a healthcare organization,formats claim and submits it to third-party payer

The standard code set up used on claim forms for inpatient claims

Which of the following code is used to describe the diagnoses, services, supplies, and procedures on the claim form?

Changes the focus to value-based care, rather than volume based care

Monthly amount paid by the patient to receive coverage?

All payer will only accept written appeals

A provider in-network for a patient's third party payer.

Part C combines part A and B coverage for medicare

the following steps of the revenue cycle involves obtaining and verifying prior authorizations for certain procedures

A payment module that reimburses for the services or procedures performed

Inpatient hospital charges

 Electronic health record applications allows for which  administrative functions