Chapter 4, Problem 5R

Do contracts give a plan the right to conduct audits of medical records and billing data related to care provided to plan members? Select one: True False.

The purpose of obtaining a health history in today's medical office is to: a. have a basis for all treatment given by the provider and a guide for all future treatment. b. have information for the patient's personal use. c. have something to document in the patient's medical record. O d. have information for the insurance company.

Drag the missing term into each sentence/paragraph text related to completion of the 837 P claim. The HIPAA 837P uses the term for the insurance diagnosis account or guarantor, meaning the same as on the CMS-1500 clalm. The name and address of any than the subscriber or patient who has is reported if applicable. party, the entity or person other responsibility for the bill, submission line filing indicator code is an administrative code used to identify data health the type of plan, such as a PPO. and the subscriber are not the same person, an code is required to specify the patient's relationship When the claim attachment individual to the subscriber. Although sometimes called the patient number, the claim number should not be the same as the practice's account insured electronic number for the patient. The claim code, also called the claim financial policyholder code, for physician practice claims indicates whether this claim is an original, a or needs to be voided. A total of four…

How does health Insurance Portability and Accountability Act (HIPAA) facilitate electronic transactions? A Gives providers access to a centralized patient database B Gives covered providers unique identifiers to use with coding system C Allows anyone with computer access to file claims D Generates paper reports as a back up system