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Med 112 Final Exam
Med 112 Final Exam Review
| Question | Answer |
|---|---|
| What do you check on military ID to make sure it's valid | Expiration date |
| When a Claim is automatically transmitted from primary to secondary payer is a | Cross-Over Claim |
| Another name for Ambulatory care | Outpatient care |
| Name the coding system for products supplies and services | HCPCS |
| What does Assumption coding mean | When coding something that was not documented by provider in the chart |
| Periodic Payment required to make to keep Insurance policy in affect | Premium |
| What section of CPT use Physical status modifiers | Anesthesia section |
| When no other information is available for assigning a more specific code what type of code is used | NOS (Not otherwise Specified) |
| Eligible members of the capitated plan are listed on the | Monthly Enrollment list |
| What list unpaid claims transmitted to payers by the length of time they remain due | Insurance aging report |
| Doctor who first treats a workers comp claim employee | Physician of report |
| What type of condition requires specific Authorization from patients other than TPO | STD, HIV, Substance Abuse, Mental Health |
| What indicates that an employer is responsible for a worker comp claim | Admission of liability |
| Preauthorization may also be called | Precertification |
| What explains how insurance companies will pay if there is more than one | (COB) Coordination of Benefits |
| You are selecting an E/M Code | History Exam, And Medical insurance Decision making |
| The term during payment Adjudication means the payer needs more information | Development |
| Hospital list of codes and their charges | Charge Masters |
| Who Coordinates and manages the care of patients | PCM Primary care Manager |
| Medicare part known as Medicare advantage | Medicare Part C |
| What type of Manage care plan is usually used in a consumer driven health plan | PPO Preferred Provider Organization |
| Medicare non-par providers can decide rather to accept assignments | on a claim by claim bases |
| How will a payer respond to a claim that has no diagnosis code | Deny the Claim |
| Name the Tricare program that offers benefits to Medicare eligible retirees and family members | Tricare for Life |
| Connection between a billed service and a diagnosis | Code Linkage |
| Medicare par providers must do what for beneficaiares | Accept assignment and file claim for beneficiaries |
| What are the advantage to patients in managed care plans compared to indemnity plan | Lower outer pocket cost, Premiums, deductible, lower Coinsurance |
| Federal Black Lung programs offer benefits for individuals who | work in coal mines |
| Individuals who enroll in a health plan after the enrollment date | Late Enrollees |
| Doctors who what to provide services for Medicaid enter into contracts with | The HHS |
| What does the Physician of record file every time theirs a change in the patients condition | Progress report |
| When the insured must pay the difference between the allowed charge and the providers charge | Balance Billing |
| If you have two surgeons working as Co surgeons on a surgery what modifier is used | Two surgeons modifier |
| A summery of the financial transactions that occur each day | Day Sheet |
| Provider who provides the procedure on the claim other that the pay to provider is called | Rendering Provider |
| Face to face meeting between a provider and a patient | Encounter |
| Medicare Part that covers care in a skilled care facility | Part A |
| A single code grouping lab test | Panel |
| Helps Practice decide if the patient is Indigent | MEAN Test |
| Authorizes the doctor to file claims for the patient and receive direct payment from the payer | Assignment of Benefits |
| What do you make on the claim for to show the insured is the patient | Self |
| What should be prepared and updated for each participating contract | Plan Summary Grid |
| Used to code procedure code during a Pt hospital stay | ICD-10-PCS |
| Document Notifying individual of a breach | Breach Notification |
| Occurs when a Procedure and diagnosis are not correctly link in the opinion of the payer | Medical Necessity denial |
| After discharging a workers comp Pt the provider must file a | Final report |
| To report and Auto accident where Pt was injured the cause code would begin with | V code |
| Main Database of hospital patient | Master Patient Index MPI |
| Another work for NOS | Unspecified |
| Period between the date of claim transmission and receiving payment | Claim Turn-Over Time |
| HIPAA Eligibility for a health plan Transaction | 270/271 |
| Type of audit preformed internally after claims are submitted | Retrospective Audit |
| Payer of Last Resort | Medicaid |
| When can you code for Suspected and unconfirmed conditions | Inpatient coding |
| Best time in which to collect patient information | Preregister Process |
| Process of determining to pay reject or deny claim | Adjudication |
| During what time can you make calls | 8am-9pm |
| To code a diagnosis first look where and the where | Alphabetical then Tabular |
| Electronic transmission of a claim | HIPAA X12-837 |
| Law that requires disclose of finance charges and late fees for payment plans | Truth in lending ACT |
| When a doctor first exams a workers comp Patient what document must be filed with the state | First report of Injury |
| E/M | Evaluation and Management |
| Limit on total of medical expenses Tricare beneficiaries are required to pay in one year | Catastrophic Cap |
| Under HIPAA Pt PHI may be shared without Certification is | TPO Treatment, Payment, Hospital Operations |
| If the doctor's charge is higher allowed charges are the repayment for the doctor is based on | The Allowed Amount |
| Who pays the out of pocket expenses | the Insured, |
| In the CCI what type of code can not be billed for the patient on the same day of service | Neutrally Exclusive |
| Percentage of each claim the insured payes | Co-Insurance |
| If a SEE Cross reference follows the main term | Look up the word after the SEE |
| Insurance contract Pt is the first Party Provider is the Second party the third party is | The insurance compay |
| Co Insurance for Medicare part B | 20% |
| Electronic equivalent of an insurance document is called a | Transaction |
| In the spend down program the beneficiary is required to pay | Part of their monthly expenses |
| Key to receiving coverage and payment form a payer is the payer defination of | Medical Necessity |
| What hospital department organizes and manages patient medical record | HIM (Health Information Management) |
| After a Consultation who takes over the Pt care | Referring Physician |
| Where can you find information as to how well Pt pay their bills | Credit Bureau |
| Where is information about Tricare Eligibility Stored | DEERS |
| Bad Debt include all collection that are classified as | Uncollectable Accounts |
| Check patient Medicaid eligibility when | Each time an appointment is made |
| Health plan for Military and their family | Tricare |
| What is the explanation of benefits called for medicare | MSN Medicare Summery Notice |
| Care provided to a pt on the same day by 2 or more physicians is called | Concurrent Care |
| Electronic format used to verify benefits | 270/271 |
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