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Insurance-Finals
Review
| Question | Answer |
|---|---|
| The purpose of ICD-9 Coding | Ease the process of claim submission- keep accurate medical records- track healthcare statistics- mandatory to submit claims |
| What is the tabular index used for | Find and assign a code that describes a disease and contains the most specific information |
| How many chapters does the tabular index have | 17 chapters |
| Where can you find diagnostic information | in radiology, lab reports, pathology reports, medical records, and encounter forms |
| Two supplementary classifications in the tabular index | E codes- V codes |
| E codes | Used to describe external causes of injury and poisoning_emergency sitiations |
| V codes | Used to describe factors influencing health status and contact with health services that cannot be classified eleswhere_office visits |
| Alphabetical index | Listing of all diagnosis, conditions, illnesses and injuries |
| cc/ chief complaint | Reason that a patient seeks medical care |
| Primary diagnosis | The condition or complaint that the patient expresses in an outpatient setting |
| Volume 1 | Tabular Index (numeric) |
| Etiology | Cause of a disorder |
| Diagnostic coding | The transformation of written descriptions of illnesses into numeric codes |
| Where do you begin your search for the diagnostic code w | In the alphabetic index |
| What is the purpose of health care insurance | To help individuals and families offset the cost of healthcare |
| What will insurance carriers cover | Services that are medically necessary |
| What will Indemnity Insurance allow | It allows you to choose any provider without an effect on reimbursement |
| To obtain preauthorization a procedure must be | Medically necessary |
| CMS 1500 Form | Claim form used to bill insurance carriers |
| What does Managed Care plans provide | Healthcare in return for preset payments |
| Two basic models of Managed Care are | HMO and PPO |
| What advantages does Managed Care plan have | Authorized services are usually covered- Preventative medical treatment is covered- Out of pocket expenses tend to be less than traditional insurance |
| Is having access to specialist an advantage | No- having access to specialist is limited |
| Who is responsible for obtaining preauthorization referral | The PCP |
| When is a referral Preauthorized | When it has been approved |
| Utilization Review | A form of patient care that is reviewed by health care professionals who do not provide care, but make sure services are "medically necessary" |
| How can HMO's be structured | IPA, Staff Model, Group Model |
| What does HMO plans require | That the patient has a PCP |
| What is an Independent Practice Association | Physicians with separately owned practices who organize into a group |
| What does group insurance cover | A number of people under no master contract |
| Medicade is for | The medically indigent |
| Who may be covered under CampVa | Veteran of the armed forces |
| Who does Tricare cover | Military dependents and retired military |
| Who is Medicare for | People over the age of 65 |
| PPO | Fee for service type of HMO |
Created by:
bossy777
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