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CBCS study
study for CBCS Test
| Term | Definition |
|---|---|
| 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
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