Question

17 Medical Billing and Reimbursement VOCABULARY REVIEW he vacabulary term to the coec denition, Wite the ansuer and tern on the linc nesto the coect next to the cornect definition Section 1 1. The process of obtaining the dollar amount 2 Obkained from health insurance companies and gives the provider 3. The electronic transfer of data (eg.electronic claims) between two or 4 A process done prior to claims submission to examine claims for 5. A contract between a provider and an insurance company in which the approved for a medical or service before the procedure or service is scheduled. b. CMS-1500 c Direct billing d. Relcase of information e Participating provider f Preauthorization approval to render the medical service. more entities accuracy and completeness health plan pays a monthly fee per patient while the provider accepts Electronic data interchange i Audit the patient's copay as payment in full for office visits 6. The process of obtaining the dollar amount approved for a medical 7. Form used by most health insurance payers for claims submitted by 8、Process by which an insurance carrier allows a provider to submit 9. A healthcare provider who has signed a contract with a health procedure or service before it is scheduled providers and suppliers insurance claims directly to the carrier electronically nsurance plan to accept lower reimbersements for services in return for patient referrals 229 Chaer 17

Answer 1

ANSWER.

1) The process of obtaining the dollar amount approved for a

    medical procedure or service before the procedure or service

    is scheduled. a. Precertification.

2) Obtained from health insurance companies and give the provider

    approval to render the medical service. d. Release of information.

3) The electric transfer of data (eg; electronic claims) between two or

   more entities. g. Electronic data interchange.

4) A process done prior to claim submission to examine claims for accuracy

    and completeness. i. Audit.

5) A contract between a provider and an insurance company in which the health

plan plays a monthly fee for patient while the provider accept the patient's copay

    as payment in full for office visits. h. Capitation agreement.

6) The procedure for obtaining dollar amount approved for a medical procedure or

   service before it is scheduled.   f. Preauthorization.

7) Forms used by most insurance payers for claims submitted by providers and

suppliers. b. CMS - 1500.

8) Process by which an insurance carrier allows a provider to submit insurance

     claims directly to the carrier electronically. c. Direct billing.

9) A health care provider sign a contact with a health insurance plan

to accept lower reimbursement for services in return for patient

    referrals. e. Participating provider.