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Certified Billing and Coding Specialist

Improper code combinations Describes the reason for a claim rejection because of Medicare NCCI edits
Appeal the decision with a provider's report Action taken if an insurance company denies a service as not medically necessary
Gross examinaion A coroner's autopsy is comprised of examination by which specimens are inspected with the bare eye
Down's syndrome conditions associated with microcephaly, a smaller than normal head circumference.
Appeal is the process used to challenge a payer’s decision to deny, reduce or downcode a claim
10-pitch PICA font font is the standard font that should be used for paper claims
Excision (Any term that ends in –ectomy indicates an excision) The subsection in the CPT manual, an esophagectomy can be found in
Attending physician is responsible for the patient’s care, as well as discharge decisions, therefore, he should be notified of abnormal lab results before the nurse can proceed with discharge planning.
Pathology and Laboratory section of the CPT manual that lists the appropriate code for white blood count (WBC) with differential automated
Check for a fourth or fifth digit To assign a diagnosis code to the highest level of specificity
Proper coding sequence of a patient who suffers 2nd degree burn of the left axilla and 3rd degree burn of wrist. 12% was burned, with 3% of the burns designated as third-degree. 3rd-degree burn of wrist; 2nd-degree bur of axilla, burn involving 10 to 19% of the body surface with less than 10% of that being third-degree burns.
Coinsurance Describes when a plan pays 70% of the allowed amount and the patient pays 30%
Clinical Laboratory Improvement Amendments (CLIA) is the accreditation agency for office laboratories, & therefore, can review manuals & interview staff
Medicine section of CPT manual where the code for hemodialysis is found
V codes are used as the first-listed diagnosis to identify health encounters that occur for reasons other than illness or injury.
Reporting test results to a family member via phone does HIPAA violation description
Private third-party payers Medigap coverage offered to Medicare beneficiaries
Endocrinologist Medical specialist who the primary care provider (PCP)) refer the patient who has a new onset of diabetes mellitus to further treat the disease
Informing the supervisor of the observation an action a billing and coding specialist takes when she observes a coworker drinking alcohol during work hours
Health care clearinghouses are covered entities (the middle man between the provider & the payer) affected by HIPAA security rules.
The claim is overdue for payment describes a deliquent claim
Aorta transports oxygenated blood from the heart
The DOB is entered incorrectly reason the claim was rejected because the patient Jane Austin's DOB was entered 052245 not 05221945
National Provider Identifier (NPI) is required to identify the rendering provider on the CMS-1500 in Block 24J According to HIPAA standards
Military Identification are required cards that pertain to retirees, active duty sponsor, and their eligible family members 10 years of age or older as a means of identification for TRICARE
Created by: CUAHIT