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physician office billing CH

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Question
Answer
fixed prepayment to medical provider for all necessary services provided to a plan member patient(Pt)   capitaiton  
payment made after the Pt receives services   retroactive payment  
amount that the insured pays on covered services before benefits begin   deductible  
a percentage of each claim that the insured pays   coinsurance  
plan in which members can visit any specialists in their network w/o a referral from their PCP   PPO  
controlled drug costs from a list of selected pharmaceuticals as determined by an HMO   formulary  
failure to perform medical duties properly   negligence  
face to cace meeting with a Pt   encounter  
concise statement that describes symptoms, problem condition or diagnosis that Pt gives during encounter   chief complaint  
electronic format used to verify benefits   HIPPA eligibility for Health Plan  
the most a payer will pay any provider for that work   allowed charge  
employers that offer health plans to employees w/o using third-party insurance carriers   self-funded health plan  
total amount that will be paid for a covered persons covered expenses during their lifetime   maximum benefit limit  
ten-digit number for the insurance policyholder or guarantor   taxonomy code  
3 government-sponsored health care programs   medicare - medicaid - tricare  
an example of a secondary provider identifier would be what?   the physicians EIN number  
violating the HIPPA Privacy Rule can result in what   both civil and criminal penalties  
medicare typically pays for what percentage of allowed charges 50, 60, 70 or 80%   80%  
how many diagnosis code pointers can be assigned to a procedure code?   4  
the NPI is used to report what on a claim   provider identifier  
a system used to encode elements of data   code set  
downcoding means   billing at a lower level code than what was proformed  
what type of coding uses diagnoses that are not coded to the highest level   truncated coding  
the physician who actually provided the service is called what   rendering provider  
CMS stands for   centers for medicare and medicaid services  
PCP   primary care provider  
EDI   eletronic data interchange  
EHR   eletronic health records  
PMP   practic management program  


   





 
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Created by: cpar on 2011-12-05



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