CRC Chapter 13 Quiz 2
EFT
Electronic Funds Transfer
EOB
Explanation of Benefits
What type of codes explain Medicare payment decisions?
MOA
MSP
Medicare Secondary Payer
If a patient has secondary insurance under a spouse's plan, what information is needed before transmitting a claim to the secondary plan?
PPO data
RA
Remittance Advice
A payer's initial processing of a claim screens for
basic errors in claim data or missing information.
What is the next step after the primary payer's RA has been posted when a patient has additional insurance coverage?
billing the second payer.
Payers should comply with the required
claim turnaround time.
Some automated edits are for
patient eligibility, duplicate claims, and non covered services.
What appears only on secondary claims
primary payer payment
A claim may be down coded because
the documentation does not justify the level of service.
What should be verified after an RA has been checked for the patient's name, account number, insurance number, and date of service?
the payment for each CPT code matches the expected amount or that all billed CPT codes are listed
Appeals must always be filed
with a specified time
