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Coding and Billing

Final Examination

Medicaid for the medically needy, medicaid card alone NOT sufficient documentation for eligibility, patients may be asked to sign waiver for noncovered services that the patient insists on receiving and must pay for
Birtday Rule parent with the earliest birthday in the calendar year is the 1st provider (not the oldest)
Group Health Plans everyone in group is eligible for insurance regardless of health status
Diagnosis if not know, code signs and symptom
IDC-9 identifies diagnoses
E- code accidents
V - Code annual physical check up
Evaluation and Management includes case management
Tricare military
Allowable Charge Maximum amount the third party payers will pay for a particular procedure or service
Upcoding deliberate increase in a CPT code
Worker's Compensation for person injured on the job 1. disability pay, 2. medical costs, 3. vocational rehab
Federal Registry rules and regulations governing health insurance and coding
Insurance Log tracks status of insurance claims
Cafeteria Plan flexible spending account
OCR optical character recognition - use MMDDYYY format
POS Point of Service - allows participants to go outside of the paln and use any provider
NON Par insurance payments are usually sent to the patient and not to the provider
Medicaid FRAUD 1. billing for services not performed, 2. billing for a more costly service than one performed 3. billing for brand name drugs when generic are dispense 4. providing unnecessary services, 5. unbundling
Medicare Preventive Services bone density, colorectal cancer screening, diabetes services, glaucoma testing, pap smears, breast exam, prostate cancer screening, mammography
Medicare Part A hospital insurance
Medicare Part B outpatient physician care
Medicare Part C managed care plans
Medicard Part D prescription drug plans
Waiver physician's office may request a patient to sign this and acknowledge financial responsibility when the patient insists on receiving treatment not covered by their insurance carrier
Indemnity Plan a type of insurance plan where the patient chooses the provider and pays a portion of the fee
Commerical Insurance any kind of insurance paid for by somebody other than the government
COBRA Provides possibility of continuation of health insurance coverage through the previous employer when a worker leaves a job
Created by: Maribeth teacher