dsh chap 10 & 11 true/false ehr

in medisoft network professional, filters are applied in the claim management dialog box
list only claims that match dialog box
when an attachment must accompany a claim filed electronically, specific information must be entered in the diagnosis tab of the case folder in medisoft network professional
insurance claims are created from within the revenue management area of the medisoft network professional
claim management area
for each service line on a claim, the payer makes payment adjudication – decision whether to (1) pay it, (2) deny it, (3) hold it for further processing, or (4) pay it at a reduced level
the hipaa x 12 276/277 health care claim status inquiry response is the standard electronic transaction to obtain the current status of a claim during the adjudication process
the hipaa standard transaction for electronic claims is the hipaa x12 837 health claim care claim, usually called the hipaa claim
the hipaa 227 transaction from the payer uses claim status category codes for the main types of repsonses
a claim that has a yellow flag in the edit status column in revenue management must be corrected before it can be sent to a payer or clearinghouse
a medical necessity denial may result from lack of a clear, correct linkage between the diagnosis and procedure
claims billed to medicare and then submitted to medicaid are called coordinated claims
crossover claims
an appeal is a process that can be used to challenge a payer’s decision to deny, reduce, or otherwise downcode a claim
capitation payments are made to physicians on a regular basis
standard statements list only those charges that are not paid in full after all insurance carrier payments have been received
remainder statements
capitation payments are entered in the claim management dialog box
are entered in the deposit list dialog box
ra’s (remittance advice) cover group of claims, not just a single claim
in cycle billing, all statements are printed and mailed at once
patients are divided into groups, and statements printing and mailing is staggered throughout the month
the purpose of an RAC (recovery audit contractor) is to audit medicare claims and determine where there are opportunities to recover incorrect payments from previously paid but non-covered services, erroneous coding, and duplicate services
eft (electronic funds transfer) occurs when the payer sends a check to the practice, and the check is taken to the practice’s bank for deposit
true
a non-sufficient funds (NSF) check is also commonly called a “bounced” or a “returned” check
true
to apply a deposit in MNP, the payment is highlighted in the deposit list dialog box, and the apply button is clicked
true