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final exam review
| Question | Answer |
|---|---|
| What do you check on military ID to make sure its valid | expiration date |
| When a claim is automatically transmitted to primary to secondary care it is called | a crossover claim |
| Another name for ambulatory care | outpatient |
| Coding system for products, supplies, and services | HCPIC’s |
| What does assumption coding mean | when you code something that wasn't documented |
| The periodic payment to keep policy in affect | premium |
| Which section of cpt used physical statice modifiers | anesthesia section |
| When no other info is available for assigning a more specific code ___ codes are used | not otherwise specified |
| Eligible members of a capitated claim 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 |
| The doctor who first treats injured employee | d |
| What type of conditions require specific authorization from patient | substance abuse, mental health conditions, STD |
| What indicates that an employer is responsible for workers comp complaint | admission of liability |
| Preauthorization may also be called ___ | precertification |
| What explains how insurance policies will pay if there's more than one | coordination of benefits |
| You are selection an ENM code what 3 components are considered | type of history, physical exam, medical decision making |
| The term ___ during adjudication means the payer needs more info | development |
| The hospital list of codes and charges | charge master |
| Who coordinated and manages patients in Tricare | PCM (primary care manager) |
| Medicare part ___ is known as Medicare advantage | C |
| What type of plan is usually in a consumer driven health plan (CDHP) | TPO |
| Medicare non par providers can decide whether to accept assignment | on a claim to claim basis |
| How will a payer respond to a claim that has no diagnosis code | they will deny the claim |
| Name Tricare program that offers benefits to Medicare eligible military retirees and family members | Tricare for life |
| The connection between bill service and diagnosis | code linkage |
| Medicare par providers must do what for beneficiaries | accept assignment and file claim |
| What are the advantages to patients with managed health plans when compared to indemnity plans | lower payments, lower deductive, lower copay |
| Federal black lung program provides benefits to those who work in | coal mines |
| Individuals who enroll in health plans after the original enrollment | late enrollee |
| Doctors who want to provide services to Medicaid patients enter into a contract with her | HHS health and human services |
| What does physical of record file with insurance carrier every time there's a substantial change in the patients condition | progress report |
| When the insured must pay the difference between allowed charge and providers charge | balance billing |
| If you have 2 surgeons working as co surgeons on a surgery what modifier do you need to use | 2 surgeons |
| Summary of financial transactions that occur each day is called | day sheet |
| The provider who provides procedure on claim other than the paid to provider is called the | rendering provider |
| A face to face meeting between patient and provider | encounter |
| Medicare part ___ covers care in nursing facility | A |
| In CPT grouping lab tests is called a | panel |
| The ____ helps the practice decide whether patient is indigents | the means test |
| What authorizes doctor to file claims for a patient and receive direct payment from payer | assignment of benefits |
| What do you mark on claim form to show the insured is the patient | self |
| What should be prepared or updated for each participation contract | plan summary grid |
| What is used to code procedures during patients hospital stay | ICD 10 PCS |
| Document notifying of a breech | breach notification |
| When a procedure and diagnosis codes are not correctly in the opinion of the payer | medical necessity denial |
| After discharging a workers compensation for patient to go back to work provider must file ____ | final report |
| To report an auto accident where patient was injured what would your cause code begin with | V |
| The ___ is the main database of the hospitals patients | master patient index |
| Another word for NOS | unspecified |
| The period between the date transmission and receipt of payment | claim turnaround time |
| What's another way to say HIPPA eligibility for a health plan transaction | 270-271 |
| What type of audit is preformed internally after claims are submitted | retrospective audit |
| The payer of last resort | Medicaid |
| When can you code for suspected or unsuspected unconfirmed | inpatient |
| The best time to begin collecting patient information | during the preregistration process |
| The process of determining to pay, reject, or deny claims | adjudication |
| During what hours can you make calls | no earlier than 8 am and no later than 9 pm |
| To code a diagnosis first look in the ___ index then confirm in the ___ | alphabetic, tabularly |
| What's the electronic transmission for claim | HIPPA 5010 837 |
| Which law discloses late fees and payment charges | truth and lending act |
| When a doctor first looks at workers comp patient what document must be filed | first report of injury |
| E/m | evaluation and management |
| A limit on total medical expenses that Tricare is required to pay in one year | catastrophic cap |
| Under HIPPA patients EHI must be shared for ___ without their authorization | TPO (treatment, payment, healthcare operations) |
| If a doctors charge is higher than the allowed amount charge his reimbursement is based on | allowed amount |
| Who pays out of pocket insurance | insurer |
| On the CCI which type of codes cannot both be billed for patient on the same day of service | d |
| Insurance contract patient is first party doctor is second party who is the third payer | payer (insurance) |
| Coinsurance for Medicaid part b | 20% |
| Electronic equivalent of business document | transaction |
| After a consultation who is responsible for patients care | referring position |
| where can you get information about how well patients pay their bills | credit bureau |
| where information about | e |
| bad debt includes all collections that are specified as | uncollectable accounts |
| you should check patients Medicaid eligibility when | each time an appointment is made |
| the health insurance for military and military family | Tricare |
| what is explanation of Medicare benefits | MSN (Medicare summary notice) |
| care provided to a patient same day at the same place by 2 or more doctors | d |
| electronic format used to verify benefits | 270-271 |
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