Understanding Health Insurance: A Guide to Billing and Reimbursement (MindTap Course List)
14th Edition
ISBN: 9781337554220
Author: Michelle A. Green
Publisher: Cengage Learning
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Medical coding
Which of the following is NOT a reason for claims being denied?
The limit for filing has expired
Diminished Standard of Care
Services not covered by the payer.
Healthcare provider ordered a service that had no medical value
Healthcare provider under which the bill was submitted has not worked at that location in 2 week
Which of the following tasks should be completed prior to claim submission?
Coding the visit
Using the UB-20 form
Provider signing the claim
Manually sending the claim
Proper patient identification meansa. actively involving patients in their own identification.b. asking a second person to verify your ID procedure.c. checking the requisition against the patient’s room number.d. scanning patient ID bands with barcode readers only.
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- Give written answer with explanation and conclusionarrow_forwardA diverse patient population like blue collar workers are hard workers. Describe any facts or tips that you think are important for your classmates to know about this select population.Discuss how the clinical assessment and diagnosis may be impacted by any special characteristics or historical background of this diverse patient population. Be sure to consider how you might avoid bias during the assessment and diagnosis process.arrow_forwardA health line for private physicians and Veterans to consult with a health administrator who has access to a team of medical staff and accounting/billing/insurance staff. the short-term, long-term, immediate implementationarrow_forward
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- With the use of Electronic Health Records most healthcare facilities and offices no longer submit a paper claim form instead of the fields in the EHR translate in the background to an electronic format of the CMS 1500 (physician claim) or a UB04 (hospital claim) form. However, it is still essential that you understand how to complete a claim form properly. In reviewing the different Blocks on the CMS 1500 form, choose a section of Blocks (as discussed in the unit) and in your own words: List the Block Numbers (i.e., Blocks 1-8), Describe what information goes into the Blocks Discuss any formatting requirements for the Blocks and what happens to a claim if the formatting is incorrect. In the second document above, CMS discusses Incomplete or Invalid Submissions. Explain how the Part A/Part B Medicare Administrative Contractors (MAC) handles these types of claims. CMS also discusses the difference between a “clean claim” and “other-than-clean claims.” Explain in your own words the…arrow_forwardTraditional Fee-For-Service coverage is selected by: A Small business employees Large groups of employees Individuals with no group plan None of the abovearrow_forwardWhich precaution would the nurse take when restarting the intravenous (IV) line after it infiltrates and needs restarting on a client diagnosed with acquired immunodeficiency syndrome (AIDS)? Select all that apply. One, some, or all responses may be correct. Mask Gown. Gloves Face shield Hand hygienearrow_forward
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