Homework Answers
1. Four types of providers
(1) Pay- to provider (2) Rendering provider (3) Billing provider (4) Referring provider.
2. Patient
3. Another person or organization that will pay the patient's amount is the responsible party.
4. Claim filing indicator code is an administrative code that points out the health plan to be used. It must be used for deciding the type of health plan.
5. Individual relationship code is an administrative code in which the patient's connection with the subscriber is stated.
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7.6 Completing the HIPAA 837P Claim Provider Information 1. List the four types of providers. (2)...
KEY TERMS MATCHING Match the definition with the correct term from the following word list. A....
KEY TERMS MATCHING Match the definition with the correct term from the following word list. A. administrative code set B. billing provider C. carrier block D. claim attachment E. claim control number F. claim filing indicator code G. claim frequency code (claim submission reason code) H. claim scrubber I. clean claims J. CMS-1500 claim K. condition code L. data elements M. destination payer N. 5010 version O. HIPAA X12 276/277 Health Care Claim Status Inquiry/Response P. individual relationship code Q....
KEY TERMS to hog ho MATCHING Match the definition with the correct term from the following...
KEY TERMS to hog ho MATCHING Match the definition with the correct term from the following word list. A. administrative code set B. billing provider C. carrier block D. claim attachment E claim control number claim filing indicator code G. claim frequency code (claim submission eason code) H. claim soruhter I clean claims Q. HIPAA XI2 837 Healh Care Claim Professional (R37P) R. line item conl nember S. National Uniform Claim Committee (NUCC) T. other ID nunber U. ostside lahoratory...
Claim Frequency Code 11. List the three types of claim frequency code. (3) Diagnosis Codes 12....
Claim Frequency Code 11. List the three types of claim frequency code. (3) Diagnosis Codes 12. How many diagnosis codes may be entered on the HIPAA 837P claim form? Claim Note 13. When is a claim note used? Service Line Information 14. Does the HIPAA 837P have the same elements as the CMS-1500 at the service line level? Diagnosis Code Pointers 15. How are diagnosis code pointers used on the HIPAA 837P claim form? Line Item Control Number 16. How...
Reviewing the definition Third-Party Payer will also assist you in completing this assignment. 1. List 3...
Reviewing the definition Third-Party Payer will also assist you in completing this assignment. 1. List 3 types of third party plans? 2. What information is required to file a third-party claim? 3. What are the steps for filing a third-party claim?
7.2 Completing the CMS-1500 Claim: Patient Information Section 1. What do Item Numbers 1 through 13...
7.2 Completing the CMS-1500 Claim: Patient Information Section 1. What do Item Numbers 1 through 13 on the CMS-1500 refer to? Where does this information come from? 2. What do Item Numbers 14 through 33 refer to? Where does this informati come from? Carrier Block 3. What information is listed in the carrier block? Patient Information 4. What information do Item Numbers 1 through 13 of the CMS-1500 contain? 5. What is the importance of completing Item Numbers 10A through...
Review Questions Match the key terms with their definitions. 1. LO 7.3 billing provider 2. LO...
Review Questions Match the key terms with their definitions. 1. LO 7.3 billing provider 2. LO 7.7 clean claim 3. LO 7.6 destination payer 4. LO 7.6 line item control number 5. LO 7.3 pay-to provider 6. LO 7.4 POS code 7. LO 7.8 claim scrubber 8. LO 7.4 rendering provider 9. LO 7.5 subscriber 10. LO 7.4 taxonomy code 11. LO 7.2 carrier block 12. LO 7.1 CMS-1500 A. Claim accepted by a health plan for adjudication . Unique...
Case 7.3 From the Patient Information Form
Provider Information Billing Provider Valley Associates, PC NPI 1476543215Address 1400 West Center Street, Toledo, OH 43601-0213Telephone 555-967-0303Employer ID Number 16-1234567Rendering Provider Christopher M. Connolly, MDNPI 8877365552Oxford PPO Provider Number 1011Oxford HMO Provider Number 2567Assignment AcceptsInformation About the Patient:Name Kalpesh ShahSex MBirth Date 01/21/2016Marital Status SingleAddress 1433 Third Avenue, Cleveland, OH 44101-1234Telephone 555-608-9772Employer Not EmployedRace WhiteEthnicity Not Hispanic or LatinoPreferred Language English Information About Insured:Name Raj ShahPatient Relationship to Insured ChildSex MBirthdate 02/16/1987Marital Status MarriedAddress 1433 Third Avenue, Cleveland, OH 44101-1234Telephone 555-608-9772Employer Cleveland...
Case 7.2 From the Patient Information Form
In the cases that follow, you play the role of a medical insurance specialist who is preparing HIPAA claims for transmission. Assume that you are working with the practice’s PMP to enter the transactions. The information you enter is based on the patient information form and the encounter form. • Claim control numbers are created by adding the eight-digit date to the patient account number, as in AA026-10042029. • A copayment of $15 is collected from...
HIPAA regulates access to personal health information for hospitals and clinics HIPAA provides exemptions for certain...
HIPAA regulates access to personal health information for hospitals and clinics HIPAA provides exemptions for certain public health functions HIPAA regulations do not apply to patients in possession of their own medical information All are correct 1 and 3 are correct 1 is correct 3 is correct QUESTION 2 Berkshire Hattaway Is one of three companies that are building a model to improve employee health status Wants to make patient care more affordable and accessible Want to become a health...
1. Describe how the physician-patient relationship is like a contractual relationship: 2. Describe how the physician-patient...
1. Describe how the physician-patient relationship is like a contractual relationship: 2. Describe how the physician-patient relationship is not like a contractual relationship: 3. Identify at least two situations where a provider has a duty to treat? 4. What term is used to describe a situation where a provider refuses to treat, when a duty to do so exists, or improperly withdraws from treatment? 5. What is the duty to protect or duty to warn in mental health and what...
KEY TERMS MATCHING Match the definition with the correct term from the following word list. A. administrative code set B. billing provider C. carrier block D. claim attachment E. claim control number F. claim filing indicator code G. claim frequency code (claim submission reason code) H. claim scrubber I. clean claims J. CMS-1500 claim K. condition code L. data elements M. destination payer N. 5010 version O. HIPAA X12 276/277 Health Care Claim Status Inquiry/Response P. individual relationship code Q....
KEY TERMS to hog ho MATCHING Match the definition with the correct term from the following word list. A. administrative code set B. billing provider C. carrier block D. claim attachment E claim control number claim filing indicator code G. claim frequency code (claim submission eason code) H. claim soruhter I clean claims Q. HIPAA XI2 837 Healh Care Claim Professional (R37P) R. line item conl nember S. National Uniform Claim Committee (NUCC) T. other ID nunber U. ostside lahoratory...
Claim Frequency Code 11. List the three types of claim frequency code. (3) Diagnosis Codes 12. How many diagnosis codes may be entered on the HIPAA 837P claim form? Claim Note 13. When is a claim note used? Service Line Information 14. Does the HIPAA 837P have the same elements as the CMS-1500 at the service line level? Diagnosis Code Pointers 15. How are diagnosis code pointers used on the HIPAA 837P claim form? Line Item Control Number 16. How...
7.2 Completing the CMS-1500 Claim: Patient Information Section 1. What do Item Numbers 1 through 13 on the CMS-1500 refer to? Where does this information come from? 2. What do Item Numbers 14 through 33 refer to? Where does this informati come from? Carrier Block 3. What information is listed in the carrier block? Patient Information 4. What information do Item Numbers 1 through 13 of the CMS-1500 contain? 5. What is the importance of completing Item Numbers 10A through...
Review Questions Match the key terms with their definitions. 1. LO 7.3 billing provider 2. LO 7.7 clean claim 3. LO 7.6 destination payer 4. LO 7.6 line item control number 5. LO 7.3 pay-to provider 6. LO 7.4 POS code 7. LO 7.8 claim scrubber 8. LO 7.4 rendering provider 9. LO 7.5 subscriber 10. LO 7.4 taxonomy code 11. LO 7.2 carrier block 12. LO 7.1 CMS-1500 A. Claim accepted by a health plan for adjudication . Unique...
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