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MAA 102 Final Review

Common errors on insurance claim forms that may be result in a claim being denied. 1.Wrong date 2. Charges not itemized 3.Missing /incomplete/invalid procedure codes
The _ _ is the date the services were performed. Date of service
an agency that handles claims and payment? 3rd party administrator
UCR may be different from the providers - -? Actual charges
When preparing ORC scannable claims, be sure to use a - date format. Month day, year
With TRICARE, the service member is called the - ? Sponsor
Individuals who are eligible for CHAMPVA - eligible for TRICARE. NOT
TRICARE is administered on a - basis Regional
With CHAMPVA, the - shares the cost of services and supplies with eligible beneficiaries The VA
indemnity plans often have annual - and a - for each visit. annual deductible and co-pay
indemnity plans are also called - for - plans Fee-for-Service
the max a 3rd party allow for a charge for service allowable charge
-of- allows/authorizes the insurance company to pay directly to the provider. Assignment of benefits
PPO, HMO,EPO, and POS are all examples of _ managed care plans
one advantage of a managed care plan is - Lower out-of-pocket costs
An example of a cafeteria plan is a - - - Flexible spending account
insurance you get through your job, coverage is available to all. Group Health Plan
When a patient pays a % of care? coinsurance
The out of pocket amount paid before health coverage goes into effect Deductible
Money collected at time of service copay
Individual who pays the premium policy holder
Workers comp is a - system. no fault
workers comp benefits include 1. Medical expenses 2. Vocational rehab 3. Disability pay 4. death benefits
Type of insurance that may be provided to patients injured on the job. worker's compensation
- allows other health plans to continue health coverage beyond cobra period COBRA
Mandatory Benefits states must provide to receive federal matching funds from MEDICAID list them 1. Impatient hospital services 2.outpatient hospital services 3. Early and periodic screening 4. Nursing facilities 5.labs and x-ray 6.certified pediatric 7.tobacco cessation 8.family planning services 9 Diagnostic services
Medicaid is run by - and - - within federal quide lines State and local government
Medicaid patients usually pay - % of their treatment with covered services 0%
Medicaid is a - program. Assistance
Medicare is run by - CMS
Medicare patients pay part of their cost through - deductibles
Medicare is an - program insurance company
A document from a provider that lists items/services is a - ABN patient must sign
The paper claim form is called the - CMS - 1500 Center for medicare services
If a person has medicaid and medicare which one is primary? Medicare
The - is the policy holder Beneficiary
With social security you are automatically enrolled in part - medicare Part A
Part - is prescription medication coverage Medicare Part D
part - choice of managed care plans Medicare Part C
Part - pays for physicians fees diagnostic test and some screening Medicare Part B
part- pays hospital services (usually free) Medicare Part A
Glyc/o Sugar/glucose
Nephr/o Kidney
-emia Blood/blood condition
cost/o Rib
neo New
when CPT code and diagnosis code do not match up down coding
When providing "pain management" services for workers comp patients, you must submit a - - using appropriate CPT-HCPCS for services Prior Authorization
If multiple modifiers are being used when coding the first modifier used is 99
E/M codes usually begin with/ - 99
CPT codes are - digits and can be further defined by - digit modifiers 5 digits , 2 Digits
ICD-10-CM: VOL. 2 is the - and VOL 1 is the - vol 2 = index Vol 1 = Tabular list
The updated version of the ICD-9 is the - ICD-10-CM
Z codes describe Circumstances other that disease, injury or external causes.
A "X" in ICD-10-CM codes is a - place holder
ICD-10-Cm 1st Character is a - letter
The first step when using ICD_10_CM is to- locate the term within the alphabetic index
NPI Numbers are issued by - CMS
Created by: shawnna1764