UDCBilling1 Word Scramble
|
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
Question | Answer |
Petty Cash | what type of fund is kept in the office and used for small business expenses in the office |
Patient Ledger | a document that contains a patient's name, services rendered, charges, payment and account balance |
CMS 1500 | is the standardized form used to submit paper insurance claims. Used for 3rd party reimbursement for Providers and other outpatient services such as Home Health Aide, Radiology and Physical Therapy |
ROI | release of information form signed by the patient Box 12 |
Patient Sections | Blocks 1-13 |
Provider Sections | Blocks 14-33 |
Rendering Provider | provider rendering services Box 31 |
Assignment of Benefits | an agreement to pay the provider directly Box 13 |
NPI # | National provider Identifier - a unique 10 digit number Box 24J CMS |
EIN # | Employee identification number - a tax id number issued by IRS Box 25 |
DEA # | Drug Enforcement Agency |
Fee Schedule | fees PCP routinely charge for medical procedures performed. based on the nationwide charge-based fees database |
Fair Debt Collection Practice Act | FTC Act which prohibits debt collectors from using abusive, unfair, or deceptive practices to collect from you |
EOB | Expanation of benefits - sent by the insurance company to patient and provider to show date, type, and charges paid or denied with explanation |
Accounts Receivable | a report that shows the pcp the amount of money received and outstanding from the insurance company and patient |
Precertification | a review to determine if the procedure can be done safely and less expensive and is covered under the policy |
Preauthorization | prior approval before the service is rendered |
Billing Cycle | chief complaint, progress notes, insurance form,electronic CMS 1500, clearinghouse, adjudication, payment position, & invoice billing |
Multiple Practice - Single Specialty | All do the same practice |
Multiple Practice - Multi Speciality | All do different practices |
Types of Schedule - Wave | schedules 3 to 4 people at the same appointment time (clinics) |
Types of Schedule - Cluster | schedules every patient for the same reason |
Types of Schedule - Fixed | pcp office hours |
Types of Schedule - Open Hours | E/R or Urgent care |
Preminum | $ amount a person pays for an insurance poliicy |
Deductible | amount patient pays before the insurance company pay |
Coinsurance | % of the allowed amount the patient is responsible to pay |
Copayment | a fixed $ amount the patient pays at each visit required by insurance policy |
Write Off | difference between the billed amount and the allowed amount is written off |
Medicare Part A | Insurance company |
Medicare Part B | pcp |
Medicare Part C | advantage (extra service not covered) |
Medicare Part D | prescription |
Medicare Suffix | letter behind the SSN ie A = wage earner |
ABN Waiver | Advanced Beneficiary Notice - covers when Medicare does not cover. Must be on file so that Medicare pays for it else you cannot bill patient |
Medicaid | Indigent, below poverty level |
Medicare | Age 60 + covers 80% Medigap or patient pays the 20% |
Disability Insurance | cannot work for physical or mental reasons. Funded by SSA |
Workers Compensation Policy | authorized by employer's adjuster. need claim # |
CHAMPVA | disabled Veterans |
TRICARE | active military |
FICA | Federal Insurance Contributions Act - tax collected to fund SS and Medicare |
Billing Cyclle | 30 60 90 |
CC | Chief complain |
ICD-9 - Diagnosis Codes | Noun - what is wrong with the patient |
CPT - Procedure Codes | Verb - what services the doctor provided includes the office visit where he gave the patient his expertise |
HCPCS Codes | durable medicals (wheel chair) and medical supplies |
E Codes | External causes that happens outside the body |
V Codes | Healthy codes when not sick |
Clearinghouse | evaluates claims and send to insurance carriers. verifies policy match name and DOB |
Scrubbing Process | Clearinghouse make sure all required data is entered accurately PCP office make sure the necessary information are filed in |
Adjudication | insurance company process of reviewing and making claims |
Denial | not covered because of ie timely filling, no preauthorization etc |
Rejection | Errors found (fixable) |
Timely Filing | reasonalbe amount of time from date of service to file a claim. ie 90 days billing cycle depends on insurance company |
Type of Accounting | Cash and Accrual (Credit) |
Payment Posting | posting insurance payments in patients account |
Modifier 24 | Unrelated evaluation and management service by the same physician during a postoperative period |
Modifier 26 | Professional component |
Modifier 32 | Mandated services |
Modifier 50 | Bilateral procedure |
Modifier 55 | Postoperative management only |
Modifier 56 | Preoperative management only |
Modifier 58 | Staged or related procedure or services by the same physician during the postoperative period |
Modifier 62 | Two surgeons |
Modifier 66 | Surgical team |
Medigap | Medigap insurance provides coverage for the remaining out of pocket expenses |
Volume II | Index |
Created by:
CUAHIT
Popular Medical sets