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