Final Review
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each of the black spaces below before clicking
on it to display the answer.
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| In coordination of insurance benefits for a child. The parent whose birthdate is first in the calendar year will be the primary plan. | show 🗑
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| show | Is billed first
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| EOB | show 🗑
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| show | Acknowledges fiscal responsibility if the insurance company doesn't pay.
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| show | A log to track the status of insurance claims
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| Statue of Limitations | show 🗑
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| show | The goal of managed care is to keep costs low. The potential benefit to the enrollee is that premiums are generally lower.
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| show | Provides continuation of healthcare coverage between jobs. (Super expensive)
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| NPI | show 🗑
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| show | Optical Character Recognition (Used to read the CMS-1500. OCR Scannable Red Ink - All Capital Letters - No punctuations)
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| show | Americans with Disabilities Act. Concerned with those who discriminate people with disabilities.
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| show | Procedure required by most healthcare plans before a provider carries out a specific procedure or service
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| show | Physician is paid based on the number of patients cared for - Paid per capita - Not on the number of visits or type of service received.
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| Allowable Charge | show 🗑
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| show | Standardization system used to facilitate 3rd party payers
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| Premiums | show 🗑
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| show | Should be collected at time of service. Usually a fixed amount.
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| Primary Care Physician | show 🗑
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| show | Criteria for payment. Service must meet the standards of good medical practice.
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| show | Person responsibile for paying the bill.
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| Co-Insurance | show 🗑
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| show | Out of pocket expense paid before coverage goes in to effect.
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| Exclusion | show 🗑
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| Tertiary Care | show 🗑
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| Coordination Of Benefits | show 🗑
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| show | Invests their own money in order to pay for it's employee's healthcare needs. 3rd party administrator is used to process claims.
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| show | International Classification of Disease, 9th Revision, Clinical Modification
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| ICD-9 is updated when? | show 🗑
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| What is in Volume 1 of the ICD-9? | show 🗑
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| What is in Volume 2 of the ICD-9? | show 🗑
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| What is in Volume 3 of the ICD-9? | show 🗑
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| What are V-Codes? | show 🗑
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| show | Identify how accidents happen. Can also determine the place of occurance. Poisoning.
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| CPT-4 | show 🗑
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| show | Used in the CPT-4. If there are multiple modifiers the code -99 will be used. It means there will be more than one modifier.
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| Who is eligible for Medicare? | show 🗑
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| show | CMS-1500
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| show | Inpatient Hospital care
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| show | Outpatient Care, Phsysician's fees, Diagnostic screening
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| show | Choice of advantage/managed care plans
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| show | Prescriptions
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| What is the Donut Hole? | show 🗑
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| What is the Medicare Benefit Period? | show 🗑
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| UCR | show 🗑
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| show | Listing of drugs the insurance company will pay for. Physician can request a drug to be added if there is good medical reason.
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| Medicaid | show 🗑
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| Medicaid Eligibility | show 🗑
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| show | Computerized database that lists all active and non active service members and their dependants
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| show | By the military
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| Who is the Tricare Sponsor? | show 🗑
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| How is Tricare administered? | show 🗑
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| show | If you have Tricare, you're not eligible for CHAMPVA. You can only have one or the other.
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| show | For those injured on the job.
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| What does Worker's Comp include? | show 🗑
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| Who pays the Premiums for Worker's Comp? | show 🗑
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| Is worker's Compensation "no fault" insurance? | show 🗑
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| show | Disability Pay, Medical Expenses, Vocational Rehab
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| What insurance program is for the needy? | show 🗑
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| show | Lower Costs and Lower Premiums
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| What are insurance premiums? | show 🗑
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| show | The policy holder
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| show | The guarantor
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| show | Provisions by which the policy holder and insurance company share costs
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| What is the out-of-pocket expense that must be paid before insurance coverage goes in to effect? | show 🗑
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| show | At the time of service
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| show | Diagnosis
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| show | Volumes 1 and 2
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| show | To code inpatient services in hospitals
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| show | January 1st
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| Before submitting ICD-9-CM codes to an insurance company what form must be filled out? | show 🗑
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| What is an insurance log used for? | show 🗑
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| Which healthcare insurance plans are more expensive? | show 🗑
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| When parents are divorced or separated, which plan is considered the primary plan? | show 🗑
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| show | CPT-4 codes
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| show | -99
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| show | Workers' Compensation
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| Who pays the premiums for Workers' Compensation? | show 🗑
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| When coordinating insurance benefits for children, what rule determines which parents has the primary insurance? | show 🗑
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| show | When both parents have insurance, the parent whose birthday comes first in the calander year has the primary insurance
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| Are participating providers allowed to "balance bill" Medicaid patients for the cost of treatment over what is reimbursed? | show 🗑
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| show | DEERS
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| Is the statute of limitations for minors extended in all states until the child reaches legal age? | show 🗑
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| On what form do we file Medicare claims? | show 🗑
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| show | Primary Insurance
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| After a claim form has been processed and payment is sent, what is the document that outlines how payment is made called? | show 🗑
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| Who manages Tricare? | show 🗑
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| Can a provider's charges be different from the UCR fees? | show 🗑
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| What code identifies accidents? | show 🗑
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| show | Physician Fees, Diagnostic tests and screenings
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| show | CMS- The Center for Medicare and Medicaid Services
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| When preparing OCR scannable claim, what rules follow? | show 🗑
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| show | The ADA - Americans with Disabilities Act
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| show | The allowable charge
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| Why do we use a standardized coding system? | show 🗑
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| What code describes a condition other than an illness? | show 🗑
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| Where can you find rules and regulations governing health insurance coding? | show 🗑
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| show | Billing for brand name drugs when generics drugs are dispensed. Billing for more services than the ones provided. Billing for services not performed. Billing more than once for the same service. Billing separately for services that should be combined.
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| show | BCCDGMPP Bone Density testing, Colorectal Cancer Screening, Clinical Breast Exams, Diabetes Services, Glaucoma Testing, Prostate Cancer Screening, Pap Test, Mammographic Screening
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