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MAA 102 Final Review
| Question | Answer |
|---|---|
| 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
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