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Coding and Billing
Final Examination
| Terms | Definitions |
|---|---|
| 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
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