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CBCS study

study for CBCS Test

TermDefinition
private payer vs commercial payer private is responsible in securing own health coverage. Commercial - government employer, group health coverage
compliance regulations most billing related cases are based on HIPAA & the False Claims Act
Medical Ethics are: Standards of conduct based on moral principals. Acting w/n ethical behavior boundaries means carrying out ones responsibilities w/ integrity, decency, respect, honesty, competence, fairness and trust
PPO care is paid for as recieved instead of in advance in form of a schedule more flixibility-out of network
cirlcle with a line through it means modifier 51 exempt
plus sign + indicates add on codes
Past Family and Social History (PFSH) consists of pts personal experiences w/ illnesses, surgeries, and injuries. Info of illness predominant in family pts educational background occupation marital status
Disability Ins policy that pays benefits in the event policyholder becomes incapable of working.
HIPAA is an Acronym for Health Information Portability Accountability Act (1996)
Chief Complaint CC the reason the pt came to see the doctor
CPT used to report services and procedures by drs
modifier -57 used on E/M services the day before or day of major surgery when the initial decision to perform the surgery is identified.
modifier -78 physician must return to operating RM to address complication stemming fr initial procedure.
modifier -79 procedure or service provide during post-operative period - not associated w/initial procedure.
Category 2 CPT Codes Supplemental Codes for Performance Measures
Level 3 Codes used locally or regionally and have been eliminated by CMS since the Implementation of HIPAA
Add on codes used for procedures that are always performed during the same operative session; as another surgery in addition to the primary service/ procedure and is never performed separately
sideways triangle means change in wording between traingles
Brackets [ ] used to enclose synonyms, alternative wording or/ and explanatory phase
TRICARE uniformed services members retirees and their families
modifier -26 Provider only provided the professional component
modifier - 51 multiple procedures
CHAMPVA Healthcare program which the VA shares the cost of covered health care services and supplies w/ eligible beneficiaries
The list of modifiers is found where in the CPT Appendix A and the front of the book
Level 1 Codes Codes found in CPT Manual
Level 2 Codes National codes for physicians and non physician service not found in the CPT level 1
Stand Alone codes contain full description to the procedure for a code
modifier - 50 bilateral
modifier - 24 E/M service is provided during postoperative period to indicate that the service is not part of postoperative care and not included in the surgical package.
3 Components for E/M codes History Physical Exam Medical Decision Making
Medicare Part D Stand alone prescription drug coverage
Who is the payor of last resort Medicaid
History (HX) The set of info the dr gathers fr pt concerning the past
Medicaid free or low cost health insurance through the state
Medicare Part B Medical Insurance Medically necessary services and supplies.
Medicare Part A Hospital Insurance Most $0 premium
category 1 CPT codes Medical Procedures
Bullet means New Procedure Code
Category 3 CPT codes Emerging Technologies
Relative Value Payment Method The Payment amount for each service pd under the physician fee schedule is the product of 3 factors; a nationally uniform relative value for service; geographic adjustment factor(GAF) a nationally uniform conversion factor for the service.
Workman's Comp job benefit that provides $ & services to employees that are injured or become sick on the job
Usual Customary and Reasonable refers to the base amount that is treated as a standard or most common charge for a particular medical service when rendered in a particular geographic area.
Parentheses ( ) used to enclose Supplementary words, non-essential modifiers
Bullets Represents a new procedure or service code added since the previous edition of the manual.
Group Health Plans Provides healthcare coverage to a select group of people
Indemnity Insurance fee for service plan that is sometimes used when a person is in between health plans
POS Point of Service pt chooses in or out of network care- convenience- cost varies
HMO Health Maintenance Organization combining a range of coverage in a group basis. a group of Doctors or other medical professionals offer care through HMO for a flat monthly rate w/no deductibles.
E Codes For durable medical equipment for use in home
Evaluation and Management (E&M codes) Are listed in the CPT manual because they are used by all different specialties
Guidelines are found At the beginning of each section and used to provide specific coding rules for that section.
Review of Symptoms ROS Inventory of the constitutional symptoms regarding the various body systems
History of present Illness (HPI) A chronological account of the development of the complaint from first sign/symptom that pt experiences to the present
Indented Codes Listed under associate and stand alone codes
Modifiers Reporting indicators that indicate the procedure or service has been altered by specific circumstance but has not changed in it's definition of code
Created by: Techgirl77