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Test 1

Petty Cash what type of fund is kept in the office and used for small business expenses in the office
Patient Ledger a document that contains a patient's name, services rendered, charges, payment and account balance
CMS 1500 is the standardized form used to submit paper insurance claims. Used for 3rd party reimbursement for Providers and other outpatient services such as Home Health Aide, Radiology and Physical Therapy
ROI release of information form signed by the patient Box 12
Patient Sections Blocks 1-13
Provider Sections Blocks 14-33
Rendering Provider provider rendering services Box 31
Assignment of Benefits an agreement to pay the provider directly Box 13
NPI # National provider Identifier - a unique 10 digit number Box 24J CMS
EIN # Employee identification number - a tax id number issued by IRS Box 25
DEA # Drug Enforcement Agency
Fee Schedule fees PCP routinely charge for medical procedures performed. based on the nationwide charge-based fees database
Fair Debt Collection Practice Act FTC Act which prohibits debt collectors from using abusive, unfair, or deceptive practices to collect from you
EOB Expanation of benefits - sent by the insurance company to patient and provider to show date, type, and charges paid or denied with explanation
Accounts Receivable a report that shows the pcp the amount of money received and outstanding from the insurance company and patient
Precertification a review to determine if the procedure can be done safely and less expensive and is covered under the policy
Preauthorization prior approval before the service is rendered
Billing Cycle chief complaint, progress notes, insurance form,electronic CMS 1500, clearinghouse, adjudication, payment position, & invoice billing
Multiple Practice - Single Specialty All do the same practice
Multiple Practice - Multi Speciality All do different practices
Types of Schedule - Wave schedules 3 to 4 people at the same appointment time (clinics)
Types of Schedule - Cluster schedules every patient for the same reason
Types of Schedule - Fixed pcp office hours
Types of Schedule - Open Hours E/R or Urgent care
Preminum $ amount a person pays for an insurance poliicy
Deductible amount patient pays before the insurance company pay
Coinsurance % of the allowed amount the patient is responsible to pay
Copayment a fixed $ amount the patient pays at each visit required by insurance policy
Write Off difference between the billed amount and the allowed amount is written off
Medicare Part A Insurance company
Medicare Part B pcp
Medicare Part C advantage (extra service not covered)
Medicare Part D prescription
Medicare Suffix letter behind the SSN ie A = wage earner
ABN Waiver Advanced Beneficiary Notice - covers when Medicare does not cover. Must be on file so that Medicare pays for it else you cannot bill patient
Medicaid Indigent, below poverty level
Medicare Age 60 + covers 80% Medigap or patient pays the 20%
Disability Insurance cannot work for physical or mental reasons. Funded by SSA
Workers Compensation Policy authorized by employer's adjuster. need claim #
CHAMPVA disabled Veterans
TRICARE active military
FICA Federal Insurance Contributions Act - tax collected to fund SS and Medicare
Billing Cyclle 30 60 90
CC Chief complain
ICD-9 - Diagnosis Codes Noun - what is wrong with the patient
CPT - Procedure Codes Verb - what services the doctor provided includes the office visit where he gave the patient his expertise
HCPCS Codes durable medicals (wheel chair) and medical supplies
E Codes External causes that happens outside the body
V Codes Healthy codes when not sick
Clearinghouse evaluates claims and send to insurance carriers. verifies policy match name and DOB
Scrubbing Process Clearinghouse make sure all required data is entered accurately PCP office make sure the necessary information are filed in
Adjudication insurance company process of reviewing and making claims
Denial not covered because of ie timely filling, no preauthorization etc
Rejection Errors found (fixable)
Timely Filing reasonalbe amount of time from date of service to file a claim. ie 90 days billing cycle depends on insurance company
Type of Accounting Cash and Accrual (Credit)
Payment Posting posting insurance payments in patients account
Modifier 24 Unrelated evaluation and management service by the same physician during a postoperative period
Modifier 26 Professional component
Modifier 32 Mandated services
Modifier 50 Bilateral procedure
Modifier 55 Postoperative management only
Modifier 56 Preoperative management only
Modifier 58 Staged or related procedure or services by the same physician during the postoperative period
Modifier 62 Two surgeons
Modifier 66 Surgical team
Medigap Medigap insurance provides coverage for the remaining out of pocket expenses
Volume II Index
Created by: Annette Nelson Annette Nelson