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The purpose of ICD-9 Coding Ease the process of claim submission- keep accurate medical records- track healthcare statistics- mandatory to submit claims
What is the tabular index used for Find and assign a code that describes a disease and contains the most specific information
How many chapters does the tabular index have 17 chapters
Where can you find diagnostic information in radiology, lab reports, pathology reports, medical records, and encounter forms
Two supplementary classifications in the tabular index E codes- V codes
E codes Used to describe external causes of injury and poisoning_emergency sitiations
V codes Used to describe factors influencing health status and contact with health services that cannot be classified eleswhere_office visits
Alphabetical index Listing of all diagnosis, conditions, illnesses and injuries
cc/ chief complaint Reason that a patient seeks medical care
Primary diagnosis The condition or complaint that the patient expresses in an outpatient setting
Volume 1 Tabular Index (numeric)
Etiology Cause of a disorder
Diagnostic coding The transformation of written descriptions of illnesses into numeric codes
Where do you begin your search for the diagnostic code w In the alphabetic index
What is the purpose of health care insurance To help individuals and families offset the cost of healthcare
What will insurance carriers cover Services that are medically necessary
What will Indemnity Insurance allow It allows you to choose any provider without an effect on reimbursement
To obtain preauthorization a procedure must be Medically necessary
CMS 1500 Form Claim form used to bill insurance carriers
What does Managed Care plans provide Healthcare in return for preset payments
Two basic models of Managed Care are HMO and PPO
What advantages does Managed Care plan have Authorized services are usually covered- Preventative medical treatment is covered- Out of pocket expenses tend to be less than traditional insurance
Is having access to specialist an advantage No- having access to specialist is limited
Who is responsible for obtaining preauthorization referral The PCP
When is a referral Preauthorized When it has been approved
Utilization Review A form of patient care that is reviewed by health care professionals who do not provide care, but make sure services are "medically necessary"
How can HMO's be structured IPA, Staff Model, Group Model
What does HMO plans require That the patient has a PCP
What is an Independent Practice Association Physicians with separately owned practices who organize into a group
What does group insurance cover A number of people under no master contract
Medicade is for The medically indigent
Who may be covered under CampVa Veteran of the armed forces
Who does Tricare cover Military dependents and retired military
Who is Medicare for People over the age of 65
PPO Fee for service type of HMO