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officebilling1,2,7,8
physician office billing CH
| Question | Answer |
|---|---|
| fixed prepayment to medical provider for all necessary services provided to a plan member patient(Pt) | capitaiton |
| payment made after the Pt receives services | retroactive payment |
| amount that the insured pays on covered services before benefits begin | deductible |
| a percentage of each claim that the insured pays | coinsurance |
| plan in which members can visit any specialists in their network w/o a referral from their PCP | PPO |
| controlled drug costs from a list of selected pharmaceuticals as determined by an HMO | formulary |
| failure to perform medical duties properly | negligence |
| face to cace meeting with a Pt | encounter |
| concise statement that describes symptoms, problem condition or diagnosis that Pt gives during encounter | chief complaint |
| electronic format used to verify benefits | HIPPA eligibility for Health Plan |
| the most a payer will pay any provider for that work | allowed charge |
| employers that offer health plans to employees w/o using third-party insurance carriers | self-funded health plan |
| total amount that will be paid for a covered persons covered expenses during their lifetime | maximum benefit limit |
| ten-digit number for the insurance policyholder or guarantor | taxonomy code |
| 3 government-sponsored health care programs | medicare - medicaid - tricare |
| an example of a secondary provider identifier would be what? | the physicians EIN number |
| violating the HIPPA Privacy Rule can result in what | both civil and criminal penalties |
| medicare typically pays for what percentage of allowed charges 50, 60, 70 or 80% | 80% |
| how many diagnosis code pointers can be assigned to a procedure code? | 4 |
| the NPI is used to report what on a claim | provider identifier |
| a system used to encode elements of data | code set |
| downcoding means | billing at a lower level code than what was proformed |
| what type of coding uses diagnoses that are not coded to the highest level | truncated coding |
| the physician who actually provided the service is called what | rendering provider |
| CMS stands for | centers for medicare and medicaid services |
| PCP | primary care provider |
| EDI | eletronic data interchange |
| EHR | eletronic health records |
| PMP | practic management program |
Created by:
cpar
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