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midterm medical bill
| Question | Answer |
|---|---|
| What do you need when HMO patient is admitted to hospital for nonemergency treatment | Preauthorization |
| How many chapters in icd10cm | 22 |
| Doctor notified of a breach | breach notification |
| Provider agrees to accept assignment | approve allowed charge as payment in full |
| Illness with long duration | chronic |
| Radiologist reads written reports x-ray- what modifier | professional component |
| What is self pay patient | he doesn't have insurance |
| Of the 4 types of exams doctor can preform which level is most complete | comprehensive |
| Personal identifiers removed | deidentified |
| Type of audit performed internally before claims are reported | prospective |
| E/m code has 3 components history, exam, and _____ | medical decision making |
| In icd10 3 character codes is used when | when it cant be further subdivided |
| What coding system describes specific products, supplies, services | HCPCS |
| What do you check mark to show a patient is the insurer | self |
| If you have a PPO, referrals to specialists are ____ | referrals to specialists are not required |
| And employed patient has 2 plans 1 is the employers plan and the other government plan. which one is primary | the employers |
| Anesthesia codes have what kind of modifiers | standard and physical status modifiers P1-P6 |
| What type of coding uses a code with a higher reimbursement rate than the correct code | upcoding |
| Employers that offer health plans to employees without using an insurance carrier | self funded |
| Doctor does surgery on both sides during the same operation what modifier do you need | bilateral procedure |
| 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 code is used to indicate where a procedure took place | POS (place of service) |
| An action that missuses money that the government has allocated | abuse |
| A process to quicky generate how much a patient owes | real time |
| Why do HMOs use a formulary | drug cost |
| The fixed prepayment for each member in a capitation contract | capitation rate |
| A retired patient with Medicare also covered under a working spouses plan, which one is primary | spouses plan |
| A vendor that does business with a covered entity is called | business associate |
| The position who actually provided the service | rendering provider |
| Patients with CDHP (consumer driven health plan) have to do this before health plan makes a payment | high deductible |
| Conditions that remain after acute has ended | sequalae |
| Two parts of CDHP | health plan, savings account |
| PPO members who use out of network providers may be subjected to | higher copays |
| The connection between billed service and a diagnosis is called | code linkage |
| Standard for identification of providers | NPI (national provider identifier) number |
| To be fully covered patients with an HMO may use ____ providers | only HMO network providers |
| If documentation in the records mentions a type of condition that is not listed you would code ____ | other |
| To code a situation for circumstances other than disease or injury use a ____ code | Z |
| If you send a claim without any diagnosis code the payer will | deny the claim |
| An impermissible use or disclosure | breach |
| What type of fees are what physicians charge to most of their patients | usual fees |
| What is the electronic transaction for claims | HIPPA X12 837 |
| After one health plan paid on a claim which insurance makes the next payment | secondary |
| In CPT E/M stands for | evaluation and management |
| What does provider complete to summarize billing information | encounter form |
| Reporting services that were not documented in the record | assumption coding |
| If a diagnosis is not determined at the first visit what should you do code the | signs and symptoms |
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