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UDCBilling1
Test 1
| Question | Answer |
|---|---|
| Petty Cash | what type of fund is kept in the office and used for small business expenses in the office |
| Patient Ledger | a document that contains a patient's name, services rendered, charges, payment and account balance |
| CMS 1500 | is the standardized form used to submit paper insurance claims. Used for 3rd party reimbursement for Providers and other outpatient services such as Home Health Aide, Radiology and Physical Therapy |
| ROI | release of information form signed by the patient Box 12 |
| Patient Sections | Blocks 1-13 |
| Provider Sections | Blocks 14-33 |
| Rendering Provider | provider rendering services Box 31 |
| Assignment of Benefits | an agreement to pay the provider directly Box 13 |
| NPI # | National provider Identifier - a unique 10 digit number Box 24J CMS |
| EIN # | Employee identification number - a tax id number issued by IRS Box 25 |
| DEA # | Drug Enforcement Agency |
| Fee Schedule | fees PCP routinely charge for medical procedures performed. based on the nationwide charge-based fees database |
| Fair Debt Collection Practice Act | FTC Act which prohibits debt collectors from using abusive, unfair, or deceptive practices to collect from you |
| EOB | Expanation of benefits - sent by the insurance company to patient and provider to show date, type, and charges paid or denied with explanation |
| Accounts Receivable | a report that shows the pcp the amount of money received and outstanding from the insurance company and patient |
| Precertification | a review to determine if the procedure can be done safely and less expensive and is covered under the policy |
| Preauthorization | prior approval before the service is rendered |
| Billing Cycle | chief complaint, progress notes, insurance form,electronic CMS 1500, clearinghouse, adjudication, payment position, & invoice billing |
| Multiple Practice - Single Specialty | All do the same practice |
| Multiple Practice - Multi Speciality | All do different practices |
| Types of Schedule - Wave | schedules 3 to 4 people at the same appointment time (clinics) |
| Types of Schedule - Cluster | schedules every patient for the same reason |
| Types of Schedule - Fixed | pcp office hours |
| Types of Schedule - Open Hours | E/R or Urgent care |
| Preminum | $ amount a person pays for an insurance poliicy |
| Deductible | amount patient pays before the insurance company pay |
| Coinsurance | % of the allowed amount the patient is responsible to pay |
| Copayment | a fixed $ amount the patient pays at each visit required by insurance policy |
| Write Off | difference between the billed amount and the allowed amount is written off |
| Medicare Part A | Insurance company |
| Medicare Part B | pcp |
| Medicare Part C | advantage (extra service not covered) |
| Medicare Part D | prescription |
| Medicare Suffix | letter behind the SSN ie A = wage earner |
| ABN Waiver | Advanced Beneficiary Notice - covers when Medicare does not cover. Must be on file so that Medicare pays for it else you cannot bill patient |
| Medicaid | Indigent, below poverty level |
| Medicare | Age 60 + covers 80% Medigap or patient pays the 20% |
| Disability Insurance | cannot work for physical or mental reasons. Funded by SSA |
| Workers Compensation Policy | authorized by employer's adjuster. need claim # |
| CHAMPVA | disabled Veterans |
| TRICARE | active military |
| FICA | Federal Insurance Contributions Act - tax collected to fund SS and Medicare |
| Billing Cyclle | 30 60 90 |
| CC | Chief complain |
| ICD-9 - Diagnosis Codes | Noun - what is wrong with the patient |
| CPT - Procedure Codes | Verb - what services the doctor provided includes the office visit where he gave the patient his expertise |
| HCPCS Codes | durable medicals (wheel chair) and medical supplies |
| E Codes | External causes that happens outside the body |
| V Codes | Healthy codes when not sick |
| Clearinghouse | evaluates claims and send to insurance carriers. verifies policy match name and DOB |
| Scrubbing Process | Clearinghouse make sure all required data is entered accurately PCP office make sure the necessary information are filed in |
| Adjudication | insurance company process of reviewing and making claims |
| Denial | not covered because of ie timely filling, no preauthorization etc |
| Rejection | Errors found (fixable) |
| Timely Filing | reasonalbe amount of time from date of service to file a claim. ie 90 days billing cycle depends on insurance company |
| Type of Accounting | Cash and Accrual (Credit) |
| Payment Posting | posting insurance payments in patients account |
| Modifier 24 | Unrelated evaluation and management service by the same physician during a postoperative period |
| Modifier 26 | Professional component |
| Modifier 32 | Mandated services |
| Modifier 50 | Bilateral procedure |
| Modifier 55 | Postoperative management only |
| Modifier 56 | Preoperative management only |
| Modifier 58 | Staged or related procedure or services by the same physician during the postoperative period |
| Modifier 62 | Two surgeons |
| Modifier 66 | Surgical team |
| Medigap | Medigap insurance provides coverage for the remaining out of pocket expenses |
| Volume II | Index |
Created by:
CUAHIT
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