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Lifecycle of a Medical Claim
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Avg score: 45% • Most missed: “The department of health and human services (hhs)”
Lifecycle of a Medical Claim
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25 Questions

1. Clearinghouse

2. Eob statement has three sections

3. Stands for the accredited standards committee x12

4. Closed/paid claims

5. An independent - not-for-profit organization - the joint commission accredits and certifies more than 15 - 000 healthcare organizations and programs in the united states. Joint commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization's commitment to meeting certain performance standards

6. Documents may be sent via telecommunications or physically transported on electronic storage media.

7. Deductible

8. Coinsurance

9. Aging report

10. Retrospective review:

11. The office of inspector general (oig)

12. Administrative simplification compliance act

13. Explanation of benefits (eob)

14. Reconciliation

15. Review that deals with accuracy—is the information contained in the documentation correct?

16. Cms-1500

17. The department of health and human services (hhs)

18. Referred to as present on admission or poa

19. Review that deals with completeness—is the documentation thorough and complete

20. Remittance advice (ra)

21. Coverage determination.

22. Selecting codes at a lower level than the service documented

23. Audit

24. The official ub-04 data specifications manual

25. Revenue codes

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