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MB302 Final Review

MB 302 Managed Care Coding Final

When does ICD-10 suppose to become effective? October 1, 2014
Proper coding can be the financial __________ or ____________ of a medical practice? Success or Faliure
When coding in ICD-9 where do you start? Volume 2 the Alpha Index
What is it called when you take the code you received from the Alpha Index and check it with the code you find in Volume 1 the tabular index? Code Confirming
ICD-9 codes that are Italicized means they can never be listed as a what? Primary position
How many digits does an ICD-9 Code have? 3 to 5 digits
How many digits does a CPT Code have? 5 digits plus a possible 2 digit modifier
How often are ICD and CPT Codes updated? Annually on October 1st
In a Point-of-Service plan can the member go in and out of network at any time? Yes
Are time limits the same for all insurance companies? No
UCR is that used mostly in reference to? Fee-for-sercice
Do most private companies accept HCPCS? Yes
When you see a diagnostic statement that says metastasize or metastatic means? To spread
The insurance industry is protected by ______________ under the federal trade commission. Special Exemption
Insurance companies are rated by the number of complaints received about them? Yes
If a patient has previous medical problems that does not have any bearing on the reasons they are coming to see that doctor at that present time, do you input it or exclude it? Exclude it
When do you see a principle diagnosis? Inpatient hospital admissions
After the main term that is bolded, in your ICD-9 book, what are the terms in parenthesizes below that called? non-essential modifiers
On your ICD-9 there is 3 places you can find a 5th digit, where is that? 1) Beginning of that Chapter 2) Beginning of that Section 3) Beginning of that Three digit catagory
What table do we use for poisoning or adverse effects of chemicals? Table of Drugs and Chemicals (E-Codes)
Malignant in reference to hypertension means what? Life Threatening
The significant contribution to the development of HMO was the what? Health Maintenance Organization Act of 1973
What do you call it when a HMO provider is paid on a fixed amount per patient? Capitation
If Kaiser Permanente Medical plan is considered a closed program this means what? Patients can Choose Physicians in network only
A Physician owned medical group is called what? PPG
A Non-Physician owned medical group is called what? IPA
If you have problems with an insurance company and they are not paying a claim who would you contact? State Insurance Commissioner
Any pending insurance claim you want to track them what type of file are you going to track them with? Tickler File
If you need to follow up on the status of an insurance claim what do we call that? Inquire or Tracer
When down coding that means the payment will be what? Less
What are the total levels of review for medicare? 5
If you have to send documents by writing for a medicare appeal, how do you want to send them? Certified mail with return reciept
If you are billing numerous CPT codes for a procedure that has one code to describe it all, this is called what? Unbundling
What is MCO? Managed Care Organization
The two categories of the HMO are what? Supplemental and Basic Health Services
To be a top notch coder in the industry you must take a course in anatomy and physiology and have a strong working knowledge of what? Medical Terminology
PCP is also known as what? Gatekeeper
What does FTC stand for? Federal Trade Commission
What is the name of the document(s) that comes back from the insurance company after the claims have been processed? Remittance Adviser (RA) or Explanation of Benefits (EOB)
Wen a Doctor gets more money than he expected on a fee schedule that is called what? Overpayment
If a Physician needs to re bill the patient for an unpaid balance you would re-bill them every how many days? Every 30 days (anything more can be considered harassment)
Created by: RacheleCarter