Final Fall 2012
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
---|---|---|---|---|---|
What is "cash flow" in a medical practice? | show 🗑
|
||||
What level of education is generally required for one who seeks employment as an insurance coder? | show 🗑
|
||||
show | Standards of conduct.
🗑
|
||||
The earliest written code of ethical principles for the medical profession is the: | show 🗑
|
||||
show | Everything that is heard, read or seen regarding the patient.
🗑
|
||||
show | Ask the relative to put the request in writing and include the patient's signed authorization.
🗑
|
||||
show | City of residence.
🗑
|
||||
Exceptions to the right of privacy rule include: | show 🗑
|
||||
show | Gunshot wounds, child abuse, and extremely contagious diseases.
🗑
|
||||
Most physician/patient contracts are: | show 🗑
|
||||
When a patient carries private medical insurance, the contract for treatment exists between: | show 🗑
|
||||
An emancipated minor is: | show 🗑
|
||||
show | To prevent duplication or overlapping of payments for the same medical expense.
🗑
|
||||
show | Pre-existing.
🗑
|
||||
The SOAP in a patient medical record charting is defined as: | show 🗑
|
||||
show | Right lower quadrant.
🗑
|
||||
When is exclusion from program participation mandatory? | show 🗑
|
||||
show | Transmission of documents relating to information on sexually transmitted diseases, any routine transmission of patient information, or transmission of documents relating to alcohol treatment.
🗑
|
||||
What level of education is generally required for entry into an insurance billing or coding specialist accredited program? | show 🗑
|
||||
To ensure continuous cash flow, what is an ideal amount of time in which an insurance claim should be submitted? | show 🗑
|
||||
What does the abbreviation MSHP designate? | show 🗑
|
||||
A physician's legal responsibility for his/her own actions as well as his/her employees' is called? | show 🗑
|
||||
show | Claims submission.
🗑
|
||||
show | The Principles of Medical Ethics.
🗑
|
||||
show | Ethics.
🗑
|
||||
show | Model the behavior you want from your callers.
🗑
|
||||
Tracnsactions in which health care information is accessed, processed, stored, and transferred using electronic trechnologies are known as: | show 🗑
|
||||
An intentional misrepresentation of the facts to deceive or mislead another is called: | show 🗑
|
||||
What is the primary purpose of HIPAA Title I: Insurance Reform? | show 🗑
|
||||
A third-party administrator who receives insurance claims from the physicians, performs, edits, and transmits claims to insurance carriers is known as a/an: | show 🗑
|
||||
If a physician contracts with an outside billing company to manage claims and accounts receivable under HIPAA guidelines, the billing company is considered: | show 🗑
|
||||
show | Priviledged communication.
🗑
|
||||
show | Privacy standards.
🗑
|
||||
If you give, release, or transfer information to another entity, this is known as: | show 🗑
|
||||
show | Avoided.
🗑
|
||||
show | HMO.
🗑
|
||||
Why was diagnostic coding developed? | show 🗑
|
||||
What must be paid each year by the policy holder before the insurance policy benefits begin? | show 🗑
|
||||
What is the consequence when a medical practice does not use diagnostic codes? | show 🗑
|
||||
A charge slip, fee ticket, and superbill are also known as: | show 🗑
|
||||
The_______ is a concise statement describing the symptom, problem, condition, diagnosis, physician-recommended return, or other factor that is the reason for the encounter. | show 🗑
|
||||
show | Annually, 3.
🗑
|
||||
show | First.
🗑
|
||||
show | Primary diagnosis.
🗑
|
||||
show | 7-10 years.
🗑
|
||||
The key to substantiating procedure and diagnostic code selections for proper reimbursement is: | show 🗑
|
||||
The chronologic recording of pertinent facts and observations about the patient's health is known as: | show 🗑
|
||||
show | Defense of a professional liability claim and because insurance carriers require accurate documentation that supports procedure and diagnostic codes.
🗑
|
||||
When a patient fails to return for needed treatment, documentation should be made: | show 🗑
|
||||
show | Morbidity.
🗑
|
||||
What does comorbidity mean? | show 🗑
|
||||
Who may accept a subpoena? | show 🗑
|
||||
show | Done.
🗑
|
||||
show | Excluded.
🗑
|
||||
A(n) ________ is a pathalogic reaction to a drugthat occurs when appropriate doses are given to humans for prophylaxis, diagnosis, and therapy. | show 🗑
|
||||
The main code book used for reporting clinical information is called the: | show 🗑
|
||||
show | Combination code.
🗑
|
||||
An E code may be used in which of these circumstances: | show 🗑
|
||||
show | Volumes 1 and 2.
🗑
|
||||
What is the table that contains a classification of substances for identifying poisoning states and external causes of adverse effects? | show 🗑
|
||||
show | Cancer that is confined to the site of origin.
🗑
|
||||
Neoplasms are ________ , _________ , and _______ . | show 🗑
|
||||
show | Life-threatening.
🗑
|
||||
show | 3, 5.
🗑
|
||||
Always code to the highest degree of: | show 🗑
|
||||
show | Fee schedule, usual, customary and reasonable, relative value of schedules.
🗑
|
||||
In medical insurance coding, the acronym CPT stands for: | show 🗑
|
||||
The direct delivery by a physician(s) of medical care for a critically ill or injured patient is: | show 🗑
|
||||
Included in a global surgery policy and a surgical package is/are: | show 🗑
|
||||
A clean claim: | show 🗑
|
||||
show | Invalid claim.
🗑
|
||||
The CMS-1500 (08-05) insurance claim form is almost always accepted by: | show 🗑
|
||||
show | "N/A and DNA".
🗑
|
||||
A(n) _______ claim is submitted to the insurance carrier via a CPU, tape diskette direct data entry, direct wire, dial-in telephone, or personal computer via modem. | show 🗑
|
||||
show | Primary, secondary.
🗑
|
||||
show | It should not be photocopied because it cannot be scanned.
🗑
|
||||
show | Do not fold insurance claim forms when mailing, do not use symbols with data on insurance claim forms, do not strike over errors when making a correction on an insurance claim form.
🗑
|
||||
A health insurance claim form (CMS-1500) is known as the: | show 🗑
|
||||
show | A physically clean claim form.
🗑
|
||||
show | Send only the information requested.
🗑
|
||||
show | Is consecutive, uses the same procedure code, and results in the same fee.
🗑
|
||||
show | Leave the blcok blank.
🗑
|
||||
show | An individual who converts to standardized electronic format and transmits electronic claims data.
🗑
|
||||
show | CPU.
🗑
|
||||
What should you do often to prevent losing data you have entered? | show 🗑
|
||||
show | Accounts receivable.
🗑
|
||||
show | The Internal Revenue Service
🗑
|
||||
show | Transmits claims to the insurance payer, performs software edits, and separates claims by carrier.
🗑
|
||||
A modem is a device used to: | show 🗑
|
||||
show | Insurance claims.
🗑
|
||||
Another name for the multipurpose billing form is: | show 🗑
|
||||
show | Verify and submit valid modiiers with the correct procedure codes for which they are valid.
🗑
|
||||
A group of insurance claims sent at the same time from on facility is known as a: | show 🗑
|
||||
show | Encryption.
🗑
|
||||
show | Password.
🗑
|
||||
When coding x-ray films taken of both knees, list: | show 🗑
|
||||
The health insurance claim form (CMS-1500) is known as the: | show 🗑
|
||||
show | Bundle.
🗑
|
||||
show | State insurance commissioner.
🗑
|
||||
If an insurance claim has been lost by the insurance carrier, the procedure(s) to follow is to: | show 🗑
|
||||
show | Be less.
🗑
|
||||
show | Redetermination.
🗑
|
||||
show | Writing off the balance of an account after an insurance company has paid its portion.
🗑
|
||||
When collecting fees, your goal should always be to: | show 🗑
|
||||
Accounts receivable are usually aged in time periods of: | show 🗑
|
||||
Messages included on statements to promote payment are called: | show 🗑
|
||||
A significant contribution to HMO development was the: | show 🗑
|
||||
show | Prepaid health plan.
🗑
|
||||
How are physicians who work for a prepaid group practice model paid? | show 🗑
|
||||
In an independent practice association (IPA), physicians are: | show 🗑
|
||||
When a physician sees a patient more thatn is medically necessary, it is called: | show 🗑
|
||||
show | Capitation.
🗑
|
||||
show | Quality improvement organization.
🗑
|
||||
show | The Centers for Medicare and Medicaid services.
🗑
|
||||
show | Once a year.
🗑
|
||||
show | Every other year.
🗑
|
||||
Some senior HMOs may provide services not covered by Medicare, such as: | show 🗑
|
||||
show | May act on the Medicare beneficiary's behalf as a client representative.
🗑
|
||||
If a check is received from Medicare and it is obvious that it is an overpayment, the insurance billing specialist should: | show 🗑
|
||||
show | Widow.
🗑
|
||||
show | Set up the public assistance programs.
🗑
|
||||
show | Medical expenses of the needy unemployed.
🗑
|
||||
show | CMS.
🗑
|
||||
Medicaid is available to needy and low-income people such as: | show 🗑
|
||||
show | Managed care programs.
🗑
|
||||
TRICARE, formerly known as CHAMPUS, is funded through: | show 🗑
|
||||
The health maintenance organization provided for dependents of active duty military personnel is called: | show 🗑
|
||||
show | 1 year from a patient's discharge from an inpatient facility
🗑
|
||||
What is the protocol to follow on receiving a request for an attending physician's statement from an insurance company on a patient who has applied for health insurance? | show 🗑
|
||||
What does bundling mean | show 🗑
|
||||
show | preferred provider organization (PPO).
🗑
|
||||
The average amount of accounts receivable should be | show 🗑
|
||||
The largest section in the CPT book is the | show 🗑
|
||||
The Part B Medicare annual deductible is | show 🗑
|
||||
The letters preceding the number on the patient's Medicare identification card indicate | show 🗑
|
||||
show | children with handicap needs who require orthopedic treatment or plastic surgery
🗑
|
||||
Privileged information is related to the treatment and progress of patients. | show 🗑
|
||||
show | is consecutive, uses the same procedure code, and results in the same fee
🗑
|
||||
show | unsecured debt.
🗑
|
||||
The official American Hospital Association policy states that "abbreviations should be totally eliminated from the more vital sections of the record, such as the | show 🗑
|
||||
B) operative notes. | show 🗑
|
||||
show |
🗑
|
||||
What is the name of the federal act that prohibits discrimination in all areas of granting credit? | show 🗑
|
||||
show | state government with partial federal funding
🗑
|
||||
show | post each patient's name and the amount of payment on the day sheet and the patient's ledger card
🗑
|
||||
show | PCM.
🗑
|
||||
show | Use care in the choice of words when leaving the message
🗑
|
||||
The Medicaid program was a direct result of | show 🗑
|
||||
show | diagnostic tests.
🗑
|
||||
What is the correct procedure to collect a copayment on a managed care plan? | show 🗑
|
||||
There are several ways to file pending insurance claims. What is the best way to file so that timely follow-up can be made? | show 🗑
|
||||
Accounts that are 90 days or older should not exceed | show 🗑
|
||||
show | The employee and the employer could be brought into litigation by the state or federal government
🗑
|
||||
Confidential information includes | show 🗑
|
||||
B) everything that is read about a patient. | show 🗑
|
||||
C) everything that is seen regarding a patient | show 🗑
|
||||
Insurance claims transmitted electronically are usually paid in | show 🗑
|
||||
A clearinghouse is a/an | show 🗑
|
||||
Back-up copies of office records should be stored | show 🗑
|
||||
Which type of bankruptcy is considered "wage earner's bankruptcy | show 🗑
|
||||
show | CC
🗑
|
||||
Part A of Medicare covers | show 🗑
|
||||
How should blocks be treated on an OCR CMS-1500 claim form that do not need any information? | show 🗑
|
||||
show | Three
🗑
|
||||
show | the end of the calendar year following the fiscal year in which services were performed
🗑
|
||||
show | Foundation for medical care
🗑
|
||||
The medically needy aged | show 🗑
|
||||
show | Rebill with a letter of explanation from the physician
🗑
|
||||
show | a law passed by Congress in 1950
🗑
|
||||
show | State the office policy and ask for the full fee.
🗑
|
||||
show | Cross out the incorrect entry, substitute the correct information, date and initial the entry
🗑
|
||||
show | use a code with a description stating "unlisted."
🗑
|
||||
Back-and-forth communication between user and computer that occurs during online real time is called | show 🗑
|
||||
show | SNOMED.
🗑
|
||||
Which of the following cases should NOT use fax transmission? | show 🗑
|
||||
show |
🗑
|
||||
C) Transmission of documents relating to alcohol treatment | show 🗑
|
||||
show | unsecured debt
🗑
|
||||
show | preestablished rates for each type of illness treated based on diagnosis.
🗑
|
||||
In the Medicare program, there is mandatory assignment for | show 🗑
|
||||
70. The HCPCS national alphanumeric codes are referred to as | show 🗑
|
||||
show | MSP
🗑
|
||||
show | Decreased cash flow
🗑
|
||||
show | gunshot wound cases
🗑
|
||||
show | five
🗑
|
||||
Who may accept a subpoena | show 🗑
|
||||
B) An authorized person | show 🗑
|
||||
An explanation of benefits document for a patient under the Medicare program is referred to as the | show 🗑
|
||||
show | Sterilization
🗑
|
||||
Medicare is a | show 🗑
|
||||
The patient is likely to be the most cooperative in furnishing details necessary for a complete registration process | show 🗑
|
||||
show | EPSDT
🗑
|
||||
What should you do if an insurance carrier requests information about another insurance carrier? | show 🗑
|
||||
If a physician accepts Medicaid patients, the physician must accept | show 🗑
|
||||
Medicaid eligibility must always be checked for the | show 🗑
|
||||
B) type of service | show 🗑
|
||||
The frequency of Pap tests that may be billed for a Medicare patient who is low risk is | show 🗑
|
||||
What is the correct response when a relative calls asking about a patient? | show 🗑
|
||||
Medical etiquette refers to | show 🗑
|
||||
The reason for a fee reduction must be documented in the patient's | show 🗑
|
||||
Payments to hospitals for Medicare services are classified according to | show 🗑
|
||||
show | tertiary care.
🗑
|
||||
show | fiscal intermediaries
🗑
|
||||
show | crossover claim
🗑
|
||||
When is the principal diagnosis applicable | show 🗑
|
||||
A new patient is one who | show 🗑
|
||||
show | October 1 to September 30
🗑
|
||||
The CPT publication is updated and revised | show 🗑
|
||||
When a medical practice has its own computer and transmits claims electronically directly to the insurance carrier, this system is known as | show 🗑
|
||||
show | operate with federal grant support under Title V of the Social Security Act
🗑
|
||||
show | 80% of the Medicare-approved charge
🗑
|
||||
show | Send a patient information brochure.
🗑
|
||||
show |
🗑
|
||||
C) Discuss fees and policies at the time of the initial contact | show 🗑
|
||||
show | permanent legal document, part of the health record
🗑
|
||||
A state-based group of doctors working under government guidelines reviewing cases for hospital admission and discharge is known as a: | show 🗑
|
||||
Medicare Part A benefit period ends when a patient | show 🗑
|
||||
The CMS-1500 claim form is divided into which of the following major sections? | show 🗑
|
||||
A Medicare prepayment screen | show 🗑
|
||||
B) monitors the number of times given procedures can be billed during a specific time frame | show 🗑
|
||||
An example of a technical error on an insurance claim is | show 🗑
|
||||
show |
🗑
|
||||
C) missing place of service code | show 🗑
|
||||
An established patient is one who | show 🗑
|
||||
An insurance claim submitted with errors is referred to as | show 🗑
|
||||
The diagnosis listed first in submitting insurance claims for patients seen in a physician's office is the | show 🗑
|
||||
OSHA stands for | show 🗑
|
||||
show | Foundation for Medical Care
🗑
|
||||
IPA | show 🗑
|
||||
PPO | show 🗑
|
||||
MCO | show 🗑
|
||||
show | Health Maintenance Organization
🗑
|
||||
show | Exclusive Provider Organization
🗑
|
||||
show | Point Of Service
🗑
|
||||
show | Physcian Provider Group
🗑
|
||||
show | A generic term applied to a managed care plan. May apply to EPO, HMO, PPO, integrated delivery system or other managed care arrangemens. MCO's are usually prepaid group plans, and physcians are typially paid by the capitation method
🗑
|
||||
show | The oldest of all prepaid health care plans. A comprehensive health care financing and delivery organization that provides a wide range of health care services with an emphasis on preventitive medicine to enrollers within a geographic area through a panel
🗑
|
||||
show | A type of managed health care that combines features of HMO's and PPO's. It is referred to as "exclusive" because it os offered to employers who agree to not contract with any other plan. EPO's are regulated under state health insurance plans.
🗑
|
||||
Physcians Provider Group | show 🗑
|
||||
show | A managed care plan in which members are given a choice as to how to receive services, whether through an HMO, PPO, or fee-for service plan. The decision is made at the time the service is necessary (ie "at the point of service") sometimes referred to as
🗑
|
||||
show | T or F-- The Health Maintenance Organization Act of 1973 required most employers to offer HMO coverage to their employees as an alternative to traditional health insurance
🗑
|
||||
True | show 🗑
|
||||
True | show 🗑
|
||||
show | T or F -- Managed care plans never rquire a CM-1500 claim form to be completed and submitted.
🗑
|
||||
show | T or F -- Usually, there are no deductibles for managed care plans
🗑
|
||||
show | T or F --A copayment in a managed care plan is usually a fixed dollar amount (predetermined fee)
🗑
|
||||
Prepaid health plan | show 🗑
|
||||
Capitation | show 🗑
|
||||
show | Practitioners in a HO program may come under peer review by a professional group called______________
🗑
|
||||
show | When a physician sees a patient more than is medically necessary, it is called________________
🗑
|
||||
show | The law states that an employer employing ____ or more persons may offer the services of an HMO clinic as an alernative health treatment plan for employees.
🗑
|
||||
Utilization review | show 🗑
|
||||
Preauthorization or Prior approval | show 🗑
|
||||
show | T or F -- All persons age 65 who meet eligibilty requirements for Medicare receive Medicare Part B
🗑
|
||||
True | show 🗑
|
||||
True | show 🗑
|
||||
True | show 🗑
|
||||
show | T or F -- Employee and employer contributions help pay for Medicare Part A health services.
🗑
|
||||
show | T or F -- Medicare covers some services by chiropractors (B)
🗑
|
||||
show | Medicare part A is run by the _______
🗑
|
||||
show | Medicare is a _________________________________
🗑
|
||||
show | The letter "D" following the identification number on the patient's Medicare card indicates a _________________________
🗑
|
||||
Hospice care | show 🗑
|
||||
show | Part B of Medicare covers_________
🗑
|
||||
The deductible not covered not covered under Medicare and copayments | show 🗑
|
||||
show | A participating physcian with the Medicare plan agrees to accept__________
🗑
|
||||
show | Medicare provides insurance for people ______ years or older who are retired on Social Security.
🗑
|
||||
both Medicare and Medicaid | show 🗑
|
||||
True | show 🗑
|
||||
show | T or F -- The Medicaid patient may be responsible for a copayment
🗑
|
||||
show | T or F --It is possible for a Medicaid patient to be on Medicaid 1 month and off Medicaid the next month
🗑
|
||||
show | T or F -- In some cases, the welfare office may grant retroactive eligibility to a patient
🗑
|
||||
True | show 🗑
|
||||
show | T or F -- If a service is totally disallowed by Medicaid, a physcian iw within legal rights to bill the patient.
🗑
|
||||
True | show 🗑
|
||||
show | T or F --Prior approval or authorization is never required in the Medicaid program
🗑
|
||||
True | show 🗑
|
||||
the blind, the disabled, the aged (65 or older) | show 🗑
|
||||
show | T or F -- Individuals who qualify for TRICARE are known as subscribers.
🗑
|
||||
show | T or F --A person retired from from a career in the Armed Forces is eligible for TRICARE until 65 years of age
🗑
|
||||
show | T or F-- All dependent 10 years of age or older are required to have a military identification card for TRICARE
🗑
|
||||
show | T or F -- A certifed nurse midwife is an authorized provider of health care for TRICARE benificiaries.
🗑
|
||||
True | show 🗑
|
||||
show | TRICARE formally known as CHAMPUS, is funded through______
🗑
|
||||
TRICARE standard, TRICARE Prime and TRICARE Extra | show 🗑
|
||||
Doctors of medicine, doctors of osteopathy, psychologists | show 🗑
|
||||
service benefit program | show 🗑
|
||||
show | The active duty service member whose family members are covered under TRICARE is called the ___________________________
🗑
|
||||
show | Individuals who qualify for TRICARE are known as ________________
🗑
|
||||
show | A person who has served in the Armed Forces of United States, especially in time of war, who is no longer in the service and has received an honorable discharge is called a/an __________
🗑
|
||||
ChampVa | show 🗑
|
||||
compliance | show 🗑
|
||||
EHIM | show 🗑
|
||||
show | An intentional misrepresentations of the facts to deceive or mislead another is________
🗑
|
||||
show | What is the primary purpose of HIPPA title I: Insurance reform?
🗑
|
||||
clearing house | show 🗑
|
||||
show | If a physcian contracts with an outside billing company to manage claims and accounts receiveable under HIPPA guidelines, the billing company is considered a _____________
🗑
|
||||
show | A confidential communication related to the patient's treatment and progress that may be disclosed only with the patient's permission is known as ___________________________________
🗑
|
||||
breach of confidentiality | show 🗑
|
||||
disclosure | show 🗑
|
||||
show | Under the HIPPA guidelines, a health care coverage carrier, such as Blue Cross/ Blue Shield that transmits health information in electronic form in connection with a transaction is called a/an_________________
🗑
|
||||
show | Individual who promises to pay the medical bill.
🗑
|
||||
Preauthorization | show 🗑
|
||||
show | Money that has to be paid monthy, quarterly, or annually to keep the policy in effect.
🗑
|
||||
consultation | show 🗑
|
||||
show | Contract that exists between the physcian and the insurance carrier.
🗑
|
||||
show | Forms of health insurance coverage in effect in the United States ( private, managed care, government)
🗑
|
||||
predetermination | show 🗑
|
||||
show | Not a consultation, but a transfer of care from one physcian to another
🗑
|
||||
precertification | show 🗑
|
||||
show | A specific amount of money that has to be paid each year before before the policy benifits begin
🗑
|
||||
show | EOB is the abbreviation for____________________
🗑
|
||||
Superbill, charge slip, patient service slip | show 🗑
|
||||
Cheddar, soap | show 🗑
|
||||
Review of systems | show 🗑
|
||||
Critical care unit or Emergency department | show 🗑
|
||||
show | Individual states generally set a minimum of ______ to ___________ for keeping records.
🗑
|
||||
Send a letter of withdrawl | show 🗑
|
||||
show | An insurance biller can or cannot escape liability by pleading ignorance.
🗑
|
||||
show | Health insurance contract is between the ________ and the ______________________________
🗑
|
||||
False | show 🗑
|
||||
false | show 🗑
|
||||
universal claim form | show 🗑
|
||||
a physcially clean form | show 🗑
|
||||
show | An insurance claim submitted with errors is referred to as ___________
🗑
|
||||
copayments | show 🗑
|
||||
show | Written description of the agreed terms of payment.
🗑
|
||||
$50 max | show 🗑
|
||||
show | The most specific diagosis code has how many digits?
🗑
|
||||
show | Acts that take advatage of others for personal gain
🗑
|
||||
show | Coding reference for physcians when medical services are performed.
🗑
|
||||
send only the information requested | show 🗑
|
||||
Electronic | show 🗑
|
||||
show | T or F --- The exchange of data in a standardized format through computer connections is known as electronic data exchange. (EDI)
🗑
|
||||
show | T or f -- Encrypted data often look like gibberish to unauthorized users
🗑
|
||||
show | A group of insurance claims sent at the same time from one facility is known as a _______
🗑
|
||||
2 weeks or less | show 🗑
|
||||
Signature | show 🗑
|
||||
show | What does an electronic remittance advice (RA) do?
🗑
|
||||
decrease cash flow | show 🗑
|
||||
s Balance | show 🗑
|
||||
Dun message | show 🗑
|
||||
Executrix | show 🗑
|
||||
true | show 🗑
|
||||
HCPCS | show 🗑
|
||||
show | Medicare found that its payers were using more than 100 diff coding systems
🗑
|
||||
hcpcs level I | show 🗑
|
||||
show | Services performed by physician & non-physician providers
🗑
|
||||
show | CMS has stated not responsible for
🗑
|
||||
show | BCBSA, Health Insurance Association of America, and CMS
🗑
|
||||
show | unanimous consent of all three parties
🗑
|
||||
hcpcs level II dental codes are located in the | show 🗑
|
||||
show | temporary indefinitley
🗑
|
||||
hcpcs modifiers provide | show 🗑
|
||||
show | Index
🗑
|
||||
show | national codes
🗑
|
||||
Always verify codes in the | show 🗑
|
||||
per day | show 🗑
|
||||
show | separate for medicare reimbursement purposes
🗑
|
||||
Clinical Lab fee schedule are developed by | show 🗑
|
||||
case mix | show 🗑
|
||||
oasis | show 🗑
|
||||
show | a software program that measures the outcome of all adult patients receiving home health services
🗑
|
||||
Decision trees __ ___ used by coders and billers for reimbursement | show 🗑
|
||||
The diagnostic & Statistical Manual (DSM) __ ___ used by coders & billers | show 🗑
|
||||
show | a tool to identify psychiatric disorders
🗑
|
||||
RBRVS | show 🗑
|
||||
show | MPFS (Medicare Physician Fee Schedule)
🗑
|
||||
show | RVU's
🗑
|
||||
show | Formula to calculate limiting charge for non-pars
🗑
|
||||
show | EOMB (explanation of Medicare Benefits)
🗑
|
||||
MSN notifies Medicare Beneficiaries of | show 🗑
|
||||
show | billing write-off or adjustment amounts to beneficiaries - it is prohibited
🗑
|
||||
CMS makes sure Medicare beneficiaries are not required to | show 🗑
|
||||
show | Federal black lung program - Workers comp - Veterans administrative benefits
🗑
|
||||
show | Speech pathologist - NP - PA - Clinical Nurse spclst (CNS)
🗑
|
||||
show | Jan 1- March 31 each year
🗑
|
||||
show | Medicare Hospital insurance covers:
🗑
|
||||
inpatient, acute care, critical access, skilled nursing facility | show 🗑
|
||||
show | begins the 1st day of hospitalization and ends when the patient had been out of the hospital for 60 consecutive days
🗑
|
||||
hospice providers | show 🗑
|
||||
Medicare limits hospice care to 4 benefit periods | show 🗑
|
||||
show |
🗑
|
||||
show |
🗑
|
||||
show | temporary hospitalization of a terminally ill dependent hospice pt. to provide relief for the non-paid person who has the major day to day responsibility for care of patient
🗑
|
||||
show | prescription drug coverage to lower the cost of prescription drugs
🗑
|
||||
show | Medicare supplementary insurance (MSI)
🗑
|
||||
Who offers Medigap | show 🗑
|
||||
what is medigap for | show 🗑
|
||||
Medicare Select | show 🗑
|
||||
non-pars can accept assignment on a __ _ __ basis | show 🗑
|
||||
show | a. can not balance bill
🗑
|
||||
b. patient must sign a surgical disclosure for all non-assigned surgical fees over $500 | show 🗑
|
||||
practitioners who must accept assignment | show 🗑
|
||||
show | advanced beneficiary notice
🗑
|
||||
show | a claim for services is likely to receive a Medicare medical necessity denial
🗑
|
||||
show | denial of otherwise covered services that were found to be not "reasonable and necessary"
🗑
|
||||
show | to ensure payment for a procedure or service that might not be reimbursed under Medicare
🗑
|
||||
You should __ obtain an ABN on every procedure | show 🗑
|
||||
medicare is primary | show 🗑
|
||||
deadline for filing claims | show 🗑
|
||||
show | Cpt for the injection, hcpcs for the medication injected
🗑
|
||||
show | Yes, CPT is HCPCS level I
🗑
|
||||
HCPCS tabular codes are organized according to | show 🗑
|
||||
when will medicare pay for ambulance service | show 🗑
|
||||
A non-physician practitioner who is certified with a Masters Degree working as a provider | show 🗑
|
||||
show | chargemaster
🗑
|
||||
medicare part a is avlbl at no cost to indvdls 65 or older who | show 🗑
|
||||
b. Had medicare-covered government employment | show 🗑
|
||||
show | Illegal
🗑
|
||||
show | opt out of medicare
🗑
|
||||
show | collect donations from Medicare beneficiaries to share the cost of mass immunizations
🗑
|
||||
two vaccines that can be roster billed | show 🗑
|
||||
show | true
🗑
|
||||
DRG-decision is not used to calculate reimbursements | show 🗑
|
||||
show | true
🗑
|
||||
Nurse Practioners | show 🗑
|
||||
For beneficiaries with Medicare as secondary payer, when should providers obtain information | show 🗑
|
||||
show | any procedure would likely be denied
🗑
|
||||
Providers that are allowed to opt out are | show 🗑
|
||||
show | disabled, paid 10 years, and
🗑
|
||||
CMS stands for CENTER FOR MEDICARE/MEDICAID SERVICES | show 🗑
|
||||
show | true
🗑
|
||||
show | true
🗑
|
||||
show | true
🗑
|
||||
show | Acknowledgement to an employee that the workers' compensation claim has been accepted or approved.
🗑
|
||||
show | Benefits paid to the person who pays a deceased worker's funeral expenses
🗑
|
||||
show | Benefits that can replace a portion of lost family income for eligible family members of workers killed on the job.
🗑
|
||||
Designated Doctor | show 🗑
|
||||
show | A physical or mental handicap, especially one that prevents a person from holding a gainful job.
🗑
|
||||
show | Programs that reimburse a covered individual for wages lost due to a disability that prevents the individual from working.
🗑
|
||||
show | Report filed by the treating physician in a state's workers' compensation case when the patient is released from medical care and is fit to return to work.
🗑
|
||||
Fraud Indicators | show 🗑
|
||||
Impairment Income Benefits | show 🗑
|
||||
Impairment Rating | show 🗑
|
||||
show | With regard to worker's compensation claims, benefits that replace a portion of any wages a worker loses because of a work-related injury or illness.
🗑
|
||||
show | Benefits that an injured worker becomes eligible for from the date of disability if the injury is the loss of both feet at or above the ankle; the loss of both hands at or above the wrist; the loss of one foot at or above the ankle; the loss of one hand a
🗑
|
||||
show | With regard to workers' compensation claims, the point in time at which an injured worker's injury or illness has improved as much as it is likely to improve.
🗑
|
||||
Medical Benefits | show 🗑
|
||||
show | With regard to workers' compensation claims, notice issued to an employee if his or her employer denies a workers' compensation claim.
🗑
|
||||
show | A representative of workers' compensation insurance plans who can assist the injured worker with the workers' compensation claim at no charge. The ombudsman is not a lawyer but knows the law as it pertains to workers' compensation claims.
🗑
|
||||
Supplemental Income Benefits | show 🗑
|
||||
Temporary Income Benefits | show 🗑
|
||||
Treating Doctor | show 🗑
|
||||
Vocational Rehabilitation | show 🗑
|
||||
Active duty service member | show 🗑
|
||||
allowable charge | show 🗑
|
||||
authorized provider | show 🗑
|
||||
beneficary | show 🗑
|
||||
show | a maximum cost limit placed on covered medical bills under TRICARE. The monetary limit that a family of an active duty member would have to pay in any given year.
🗑
|
||||
catchment area | show 🗑
|
||||
show | Aged, blind, or families and children who meet financial eligibility requirements for Aid to Families with Dependent Children, Supplemental Security Income, or and optional state supplement.
🗑
|
||||
Coinsurance | show 🗑
|
||||
show | a small fixed fee paid by the patient at the time of an office visit
🗑
|
||||
show | Specific services and supplies for which Medicaid will provide remibursement
🗑
|
||||
show | Medicaid's prevention, early detection, and treatment program for eligible children under the the age of 21.
🗑
|
||||
fiscal agent | show 🗑
|
||||
Maternal and Child Health Program | show 🗑
|
||||
Medicaid | show 🗑
|
||||
Medi-Cal | show 🗑
|
||||
medically needy | show 🗑
|
||||
show | The requirement for written documentation of permission to use project funds for purposes not in the approved budget, or to change aspects of the program from those originally planned and approved.
🗑
|
||||
show | a person who receives an organ or tissue transplant
🗑
|
||||
show | the amount a patient must pay each month before medicaid will pay anything
🗑
|
||||
show | allows states to create or expand existing insurance programs, providing more federal funds to states for the purpose of expanding Medicaid eligibility to include a greater number of currently uninsured children.
🗑
|
||||
show | a federal program established to provide assistance to elderly persons and disables persons
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
lb_tc40