correct spelling for the process of branching in two
correct spelling for harmless, not cancerous
deficiency in all (blood) cells
pertaining to between the ribs
correct spelling for symptoms that occur together
correct spelling for living together for mutual benefit
correct spelling for beyond control (spread)
slow heart rate
correct spelling for complete flow of the colon
pertaining to after birth
correct spelling for after death
correct spelling for substance against germ life
blood condition of less than normal sugar
correct spelling for new born
correct spelling for protein made by leukocyte to fight infection
assignment of benefits
The authorized signature of the patient for payment to be paid directly to the physician for services
a pre-determined amount that the insured must pay each year before the insurance company will pay for an accident or illness
a system of medial team members and groups who provide quality and cost effective care that encompasses both healthcare delivery and payment for services
Normal amount range for HMO co-payment (from book)
HCPCS Level II 'J' codes depict these
established to aid dependents of active service personnel, retired service personnel and their dependents, and dependents of service personnel who died on active duty wth a supplement for medical care in military of Public Health Service facilities
the date when the insurance policy goes into effect
a joint funding program by federal and state governments (excluding AZ) for low income patients on public assistance for their medical care
Type of HMO where physicians are reimbursed on a capitated basis
To determine a code, the name of the procedure or service that most accurately identifies the service performed is selected. You are looking in this book?
Established for the spouses and dependent children of veterens who have total, permanent, service connected disabilities
a primary care physician who coordinates the patient's hosptial admissions, care received from specialists and so on
Prior authorization for hosptial admission and some outpatient and in-office procedures
type of HMO where you would find different specialties all in the same location
correctly and completely
A coding rule: code ____ and ____ any diagnosis or procedure that affects the care, influences the health status, or is a reason for treatment on that visit
coordination of benefits COB
Procedures used by insurers to avoid duplication of payment on claims when the patient has more than one policy
insurance offered to all employees by the employer
a condition that existed before the insured's policy was issued
independent practice association IPAs
Type of HMO that is composed of individual health care providers joined together to provide prepaid healthcare to groups and individuals
You always need a copy of this to complete the insurance claim form
copayment or co-insurance
a specified amount that the insured must pay toward the charge for professional services rendered
health maintenance organization HMO
a prepaid group practice serving a specific geographic area with a wide range of comprehensive health care at a fixed fee schedule
the geographic area served by an HMO
does not meet NCQA standards
a reason why accreditation would be denied to an HMO
consent to release of information to the ins company
You must have patient's signature before processing a claim...why?
the person who is insured; an insurance policy holder
individual and group
Two types of insurance
Reimbursement rate for medical (percentage)
follow up by calling the insurance company
If you have filed a claim and have not received payemnt or a denial, you should do this
in a managed care delivery system, this person is responsible for coordinating all care for the patient
a printed form containing a list of the services with corresponding codes (encounter form)
any individual may buy individual health insurance by paying this required payment?
traditional indemnity insurance coverage is often referred to as this type of plan (ratio)
the charge physicians make to their private patients
patient is primary and spouse is secondary
A husband and wife both have insurance coverage that overlaps through their employers. The wife comes in to be seen. This insurance is considered her primary.
social and alpha character
a Medicare patient's health insurance claim number is comprised of these?
shorter turn around time, decreased prep time
what are the advantages of processing claims electronically?
costs less and is more comprehensive
what are the benefits of group health insurance?
a review by allied health professionals at predetermined times to assess the necessity of the patient remaining in an acute care facility
this insurance allows patients to choose their provider and see specialists without referrals?
The year Medicare began providing coverage for one routine physical exam per year
businesses with less than 10 FT employees including phys
The only practitioners that can currently bill Medicare with the hard copy of CMS-1500 form are?
If information is given to a third party without the signed authorization of the patient, the one who gave the information may be charged with breach of this?
workers compensation WC
a government program that provides insurance coverage for people injured on the job or who have developed work-related disorders, disabilities, or illnesses
these plans integrate the financing and appropriate delivery of services to covered persons by contracting providers for comprehensive health care services, with specific standards for the providers' specialty, and maintaining programs for quality assurance and utilization review.
welcome to medicare
this is a type of physical Medicare pays for?
pay close attention to all necessary details when preping forms
How you can ensure prompt payment?
Usually, the physician agrees to treat people enrolled in the program for an agreed this?
workers compensation WC
Employees in the US have the benefits of being covered by these laws if injured while working or becoming ill as a result of work.
the two standard non-menclature code books (ICD and CPT) are published this often and are absolutely essential to the function of the medical office
to cover hosptial expenses
the reason why Blue Cross was originally set up?
Who is mainly responsible for filing claims
med care, temp disability, perm disability, family pay fatal injury
Four types of benefits under WC -pt can be seen in our out of hospital for med care -temporary disability, week or monthly cash benefits and med care -perminant disability, cash benefits and med care possible lump sum -family member pay if fatal injury
has the least amount of structural guidelines for patients to follow
annual exams and physicals
HMOs focus on these to promote health maintenance?
on their company website online
insurance companies usually publish their provider directories here
birthday rule, according to parents birthday first on calander year
When a child is covered by two insurance policies (one from each parent) you follow this rule (explain it as well)
health coverage for the medically indigent?
These type of insurance plans usually have deductibles and copayment requirements and the office usually files claims for services rendered?
HMO takes the place of traditional
If a patient has a Medicare HMO they cannot also have traditional Medicare. Why?
what is the primary purpose of HMOs?
reasons why physicians opt not to see Medicaid patients?
how often are physicians required to register with the state WC board?
When were all Medicare claims required to be submitted electronically?
this rule states that the reason for a patients visit is coved first?
Your physician accepts Medicaid patients. Does he have to accept Medicaid HMO patients?
non covered charge or service
physicians only have to notify Medicare patients of charges for this reason?
history, exam, medical decision, counseling, coordination of care, nature of presenting problem, time spent
what are the 7 components used in defining the levels of e/m services?
e&m, anesthesiology, surgery, radiology, pathology & labs, medicine
what are the six sections in which hte main body of the CPT codes are listed?