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MED112 Midterm revie
| Question | Answer |
|---|---|
| What do you need when an HMO patient is admitted to the hospital for non emergency treatment | Pre-Authorization |
| How many chapters in the ICD-10-CM | 22 Chapters |
| Document notifying an individual of a breach | Breach Notification |
| What does it mean if a provider agrees to accept assignment | Will accept payer's allowed charge as payment in full |
| An illness with a long duration | Chronic illness |
| A radiologist reads and prepares a written report for an x-ray what modifier is needed | Professional Component |
| What is a self pay patient | Uninsured patient |
| Of the 4 types of exams a doctor can preform what level is the most complete | Comprehensive (Most Detailed) |
| When personal Identifiers have been removed | De-Identified |
| Type of Audit performed internally before a claim is report | Prospective Audit |
| E/M Codes have 3 components History, Physical exam, | Medical decision making |
| In ICD-10 a 3 character code is used when | It can't be further subdivided |
| What coding system book describes products and supplies | HCPCS |
| What would you mark to show that the insured is the patient | Self |
| If you have a PPO referrals to specialist are | not required |
| an employed patient has 2 plans | (Primary) Employer & Government Plans |
| Anesthesia codes have what type of modifiers | Standards and Physical status modifiers P1-P6 |
| What kind of code has a higher reimbursement code rate than the correct code | Up-Coding |
| Employers that offer health plans to employees without using an insurance company | Self Funded plans |
| A Doctor does surgery on both side what modifier do you use | Bilateral Procedure modifier |
| When the patient pays the difference between the providers charge and the allowed charge | Balance billing |
| Primary diagnosis code is listed | First |
| What kind of coded is used to identify the location of a service | POS Place of Service code |
| An action that misuses money the government has allocated | Abuse |
| A process to quickly generate how much a patient owes | Real Time Adjudication |
| Why do HMOs use a formulary | To control Drug Cost |
| Fixed Prepayment for each member in a capitation contract | Capitation Rate |
| Retire patient with Medicare also covered under a working spouse plan which is primary | Spouses plan |
| A Vender that does business with a Covered Entity | Business Associate |
| Physician that provides the service | Rendering provider |
| Name the Paper Claim form | CMS 1500 |
| Patient with a CDHP have to do this before the insurance company pays/kicks in | Pay a high deductible |
| Conditions that remain after a acute illness has ended | Sequalae |
| Two parts of CDHP | Health plan and Savings account |
| PPO Members that use an out of network providers may be subjected to | Higher Copays |
| Connection between a billed service and Diagnosis | Code Linkage |
| Standard for identification of providers | NPI National provider Identifier number |
| To be fully covered patient with and HMO may use the services of | Only HMO Network Providers |
| If documentation in the record mentions the type of condition not listed you would record | Other |
| To code a situation for Circumstances other than disease or injury use a | Z Code |
| If you send a claim without a diagnosis code the payer will | Deny the claim |
| An impermissible use or disclosure of information | Breach |
| What fees do Physician's usually charge their patient | Usual fees |
| Electronic transaction for claims | HIPAA X12 837 |
| After one health plan has paid on a claim which insurance make the next payment | Secondary |
| In CPT E/M stands for | Evaluation and Management |
| What does the provider complete to summarize billing information | The encounter form |
| Reporting service that were not documented in the record | Assumption coding |
| If a diagnosis is not determined at the first visit | Code signs and symptoms |
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