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CBCS exam prep
| Question | Answer |
|---|---|
| the phases of the revenue cycle | preregistration, financial responsibility, check in, coding compliance, billing compliance, check out, prepare and transmit claims, adjudication, patient statements, follow up |
| what are the different types of health plans? | indemnity, managed care: hmo, pos, ppo, cdhp |
| HITECH | health information technology for economic and clinical health act: promote use of hit, mainly ehrs, by financially incentivizing |
| affordable care act | main goal was to reduce number of uninsured, helped develop accountable care orgs (network that shares quality and cost with a group of patients, improves quality through incentives) |
| stark law | prohibits self-referrals that benefit providers due to their financial relationship with other providers |
| false claims act | prohibits submitting a false statement or fraudulent representation relating to a claim, also encourages reporting of fraud |
| assignment of benefits | signing to allow providers to directly bill and receive payment from payers |
| insurance verification process | hipaa standard transaction used is 270/271, eligibility inquiry/response |
| icd-10-cm codes | international classification of diseases, clinical modification; used in outpatient settings (pcs is used for inpatient) |
| not elsewhere classifiable | there is no code specifically for the condition, no code matches the situation |
| not otherwise specified | unspecified, use the code located in the tab list when not completely described in the medical record |
| brackets | means that code cannot be the first listed |
| parentheses | nonessential modifiers for main or subterms |
| inclusion vs. exclusion notes | annotated to include all not other wise specified of a category; 1) two conditions could not exist together, 2) "not included here," but could exist together |
| cpt codes | organized by evaluation and management, surgery, radiology, pathology, and medicine |
| modifiers | two-digit number attached to a cpt code to communicate altered circumstances |
| add-ons | with a cpt code, represents an secondary procedure performed by the same provider on the same day, indicated by a plus |
| category I codes | five digit codes for procedures used by all types of physicians, most numerous of cpt codes |
| category II codes | optional codes used to track performance measures, improve documentation, alphabetic fifth character |
| category III codes | temporary codes used for new technology, services, and procedures, alphabetic fifth character |
| unlisted procedures | codes found in the section guidelines, for procedures not fully described by any other code, have not yet been assigned category I or III code |
| cpt symbols | bullet = new procedure, triangle = descriptor changed, facing triangles = enclose new/revised text that is not the descriptor, plus = add-on code, star = telemedicine code, lightning bolt = vaccines submitted and awaiting approval from the fda |
| hcpcs level I codes | current procedural terminology or cpt codes |
| hcpcs level II codes | a letter and four numbers, twenty sections, covers codes not included in level I or cpt codes |
| cpt vs. hcpcs | numeric, for procedures, maintained by the ama; alphanumeric, for supplies, products, and services not included in cpt, maintained by cms |
| fee schedules | resource - difficulty, overhead, relative risk vs. charge - providers with similar training and experience; usual, customary, and reasonable; relative value scale - base unit, relative value unit, multiplied by a conversion factor |
| rbrvs | resource-based relative value scale - 1) three elements: physicians work, overhead, malpractice insurance, 2) geographic practice cost index: number used to multiply rv element to reflect a regions relative costs, 3) nationally uniform conversion factor |
| capitation | a fixed prepayment, capitation rate, for each member in exchange for access to providers |
| parts of medicare | a) hospital coverage, b) physician coverage, c) medigap/supplmental private coverage, d) prescription coverage |
| medicare appeals process | redetermination, reconsideration, administrative judge hearing, medicare appeals council, federal court review |
| payment formula | charge - deductible - patient coinsurance = health plan payment |
Created by:
user-1993950