Question

CHAP 9 KEY TERMS/ABBREVIATIONS-RECEIVING PAYMENTS & INSURANCE PROBLEM SOLVING ( please define )

1. Advance Beneficiary Notice of Non coverage

2. aging report

3. appeal

4. delinquent claim

5. denied claim

6. explanation of benefits

7. inquiry

8. insurance payment posting

9. medical necessity

10. rejected claim

11. remittance advise

12. suspended claim

13. tracer

ABBREVIATION:

1. CMS

2. EOB

3. HIPAA

4. HMO

5. NPI

Answer 1

ANSWERS :

DEFINTIONS :

1. ADVANCE BENEFICIARY NOTICE OF NON COVERAGE : It is issued by providers(including indeoendent laboratories,home health agencies,and hospices),physicians,practitioners and supppliers to original medicare beneficieries in situations where medical care payment is expected to be denied.
2. AGING REPORT : It is a report that list unpaid customer invoices and unused credit memos by date ranges.It is used as a gauge to determine the financial health of a companies customers.
3. APPEAL : Request for your health insurance company to review a decision that denies a benefit or payment.
4. DELINQUENT CLAIM : Refers to a situation where a borrower is late or over due on a payment.
5. DENIED CLAIM : It is the refusal of an insurance company to honor a request by an insividual to pay for health care services obtained from a health care professional.
6. EXPLANATION OF BENEFITS : It is a statement sent by a health insurance company to covered individuals explaining what medical treatments and services were paid for on their behalf.
7. INQUIRY : Priliminary response from prospective customers,generally following an advertisement of sales promotion campaign.

ABBREVATIONS :

CMS : Centers for Medicare and Medicaid Services.

EOB : Explanation of Benefits.

HIPAA : Health Insurance Portability and Accountability Act.

HMO : Health Maintenance Organization.

NPI : National Provider Identifier.