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158 terms

CBCS

CBCS
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Capitation
When the healthcare provider is paid a fixed amount
Service and Procedure Based
The CPT coding system is
5 Digits (282.60)
An ICD-9-CM sublassification code must have?
MM/DD/CCYY
The patients birth date on the CMS-1500 form is entered in which of these formats?
Special Report
A service that is rarely provided, unusual, variable, or new may require a __________ in determining medical appropriateness of the service.
Indemnity
A type of insurance whereby the insured pays a specific amount per unit of service and the insurer pays the rest of the cost is called
Dread Disease Rider
A rider added to a policy to provide additional benefits for certain conditions is called
Stipulations
Rules that insurance companies have that service be outpatient or inpatient are called
Gastrectomy
Gastric resection
Osteitis
Inflammation of a bone
Cystoscopy
Visual examination of the urinary bladder
Hepatoma
Tumor of the liver
Mammary gland
What gland is not an endocrine gland?
Iatrogenic
Pertaining to produced by treatment
Electroencephalogram
Record of electricity in the brain
Diagnosis
Made on the basis of complete knowledge about the patient's condition
Cancerous tumor
Carcinoma
Biopsy
Microscopic examination of living tissue
Cephalic
Pertaining to the largest part of the brain
Adenectomy
Removal of a gland
Arthralgia
Pain in a joint
Leukemia
Increase in numbers of malignant white blood cells
Opthalmoscope
Instrument to view the eye
Thrombocyte
A platelet
Rhinitis
Inflammation of the nose
Cytology
Study of cells
Transhepatic
Pertaining to through the liver
Nephrosis
Abnormal condition of the kidney
Osteotomy
Incision of a bone
Hyperglycemia
High level of sugar in blood
Code of Hammurabi
Earliest written code of ethincal principles for the medical profession
The Principles of Medical Ethics
What is the name of the modern code of ethics that the American Medical Association (AMA) adopted in 1980?
Waiver
An attachment to an insurance policy that excludes certain illnesses or disabilites that would otherwise be covered is referred to as
Name the 6 main sections of CPT code range
Evaluation & Management 99201-99499
Anesthesia 00100-01999 / 99100-99140 (smallest section)
Surgery 10021-69990 (largest section)
Radiology 70010-79999
Pathology / Laboratory 80048-89356
Medicine 90281-99199 / 99500-99602
Semicolon (;)
These symbols are used so that test does not need to be repeated for an entire range of codes
Bullet
This symbol preceding a CPT code means the code is new for that particular year
Triangle
This symbol preceding a code means the code has undergone a revision to the description from the previous year
Double Arrows (<>)
Used to identify new and revised text
A plus sign (+)
indicates an add-on code
Circle with a slash through it
Used to identify codes exempt from modifer 51
Bull's Eye
This symbol was added to indicate those procedures in which the provision of moderate sedation services is considered to be inherent and, therefore, not separetly reported by the same physician performing the primary service.
Lightning Bolt
This convention was added to highlight products that are awaiting U.S. Food and Drug Administration (FDA) approval
21
Prolonged evaluation & Management
Unusual procedural services
22
Unusual aneshesia
23
Unrelated E/M service by the same physician during a post-operative period
24
Significant, separately identifiable E & M service by the same physician on the day of a procedure
25
Professional component
26
Mandated Services
32
Bilateral procedure
50
Multiple procedures
51
Reduced services
52
Decision for surgery
57
Staged or related procedure or service by the same physician during the post-operative period
58
Distinct procedural service
59
Repeat procedure by the same physician
76
Return to the operating room for a related procedure during the post-operative period
78
Unrelated procedure or service by the same physician during the post-operative period
79
Assistant surgeon
80
Reference (outside) laboratory
90
Multiple modifiers
99
A claims assistance professional
Works for the consumer and helps patients file insurance claims
What is the name of the modern code of ethics tha the American Medical Association (AMA) adopted in 1980?
The Principles of Medical Ethics
An attchement to an insurance policy that excludes certain illnesses or disabilities that would otherwise be covered is referred to as a
Waiver
Mrs. Thompsett leaves her place of employment. She is eligible to transfer her medical insurance coverage from a group to an individual contract. This is known as
Conversion privlege
Why would conversion from a group policy to an individual policy be advantageous?
No physician examination required
A patient intake sheet is also called a
Patient registration form
The first document obtained in the initial patient visit is a
Patient information sheet
The source document for insurance claim data is the
Super bill
A medical record is considered
medical information and a health record
A medical report is a
Permanent legal document and part of the medical record
Parts of the small and large intestines, right ovary, right uterine tube, appendix, and right ureter are found in the
Right lower quadrant
Preservation of medical records is governed by
State and local law
When is the principle diagnosis applicable?
Inpatient hospital coding
E codes are used
to show external cuase of injury
What is the name of the book used in the physicians office to code procedures?
Current Procedural Terminology (CPT)
The term "encounter records" means
Claim
Input of data into a computer system requires the use of a
Keyboard
Another name for instructions that make the computer perform a specific task is
Software
The storage capacity of a computer is measured in
Bytes
The smallest unit of storage possible in a computer is the
Bit
Back and forth communicaiton between user and computer that occurs during on-line real time is called
Interactive transaction
What is the name of the act designed to address the collection practices of third-party debt collectors and attorneys who regularly collect debts for others?
Fair Debt Collection Practices Act
America's oldest privately owned, prepaid medical group is the
Ross-Loos Medical Group
Kaiser Permanente's medical plan is a closed panel program, which means
It limits the patient's choice of personal physicians
When an HMO is paid a fixed amount for each patient serviced without considering the actual number or nature of services provided to each person, this is known as
Capitation
How are physicians paid who work for a prepaid group practice model?
Salary paid by independent group
The letters preceding the number on the patients Medicare identification card indicate
Railroad retiree
Medigap insurance may cover
the deductible not covered under Medicare
Under the prospective payment system (PPS), hospitals treating Medicare patients are reimbursed according to
Preestablished rates for each type of illness treated based on diagnosis.
The 1987 Omnibus Budget Reconciliation Act (OBRA) established the
MAAC
RBRVS was established as a means to
redistribute Medicare dollars among physicians more equitably
Organizations handling claims from hospitals, nursing facilities, intermediate care facilities, long-term care facilities, and home health agencies are called
Fiscal intermediaries
The Medicaid program was a direct result of
a law passed by Congress in 1950
The medically needy aged
require help in meeting costs of medical care
The federal aspects of Medicaid are the responsibility of
CMS
The Omnibus Budget Reconciliation Act
Provided assistance for the aged and diabled who are receiving Medicare and whose incomes are below the poverty level.
TRICARE, formerly known as CHAMPUS, is funded through
Congress
People NOT entitled to benefits under TRICARE are
CHAMPVA beneficiaries
What is the system called that TRICARE claims processors use to verify beneficiary eligibility?
TRI-CHECK
A physician who chooses not to participate in TRICARE bills
no more than 115% of the Tricare allowable charge.
The time limit within which a TRICARE inpatient claim must be filed is within
one year from a patients discharge from an inpatient facility.
The statutes for workers compenatjion laws fall under
Federal and state compensation laws
When a case is rated for permanent disability and settled, this is called
Compromise and release
In a PD (permanent disability) claim, the physicians final report must include the words
Permanent and stationary
The code book used to list procedures on outpatient hospital claims is
CPT
The form that accompanies the billing claim form for inpatient hospital services is called a
Detail statement
A claims assistance professional should promote and market to
Medicare receipients
What association maintains and publishes CPT coding guidelines, codes, and descriptions?
AMA
What are the three categories of CPT codes?
Category I, II, III
What are three methods procedural main terms are listed in the CPT manual alphabetical index?
Condition, synonyms, abbreviations
What three components are used to configure Relative Value Units?
Malpractice insurance cost, physician work, practice expense
What are the definitions for facility and non-facility RVU expenses for calculating physician fee schedule payment amounts?
Non-Facility includes privately owned physician practices
Facility includes skilled nursing facilities, nursing homes, hospitals
Which CPT code set is used voluntarily by physicians to report quality patient performance measurements?
CPT Category II Codes.
CPT category III codes are reported to indicate which type of service or procedure?
New and emerging
Which CPT Appendix lists clinical examples for E/M coding?
Appendix C
Neurectomy
Resection of a nerve
Pericardium
Membran surrounding the heart
What is the correct term used to determine if a procedure is covered and medically necessary
Preauthorization
The computer output device is the
Printer
The type of memory in which data may be stored and read but not changed is
ROM
An ECP is
an individual who converts insurance claims to standardized electronic format and transmits electronic claims data.
A computer printout that is used to look for errors before an insurance claim is transmitted electronically is called
an insurance billing worksheet
The _______ describes whether specific medical items, services, treatment procedures, or technologies are considered medically necessary under Medicare.
National Coverage Determinations
LCDs only have jurisdiction in their ______area.
Regional
A covered entity does not include
Patient
Arthritis is an inflammation of what?
Joint
A procedure that widens a narrowed vessel or obstructed blood vessel is name an
Angioplasty
A patient is diagnosed with inflammation of the testis and epididymis. The medical term for this condition is called
Orchiepididymitis
Adrenomegaly is defined as
Enlargement of the adrenal gland
What is the Rhinne test?
Test that measures hearing using bone conduction and air conduction
A sialography is an x-ray of
Salivary glands
In an independent practice association (IPA), physicians are
not employees and are not paid salaries
A program that offers a combination of HMO-style cost management and PPO-style freedome of choice is a
Point of service (POS) plan
The frequency of Pap tests that may be billed for a Medicare patient who is not at risk is
Once every 3 years
A state-based group of doctors working under government guidelines reviewing cases for hospital admission and discharge is known as
PRO
RVU component consists of a
RVU component, GAF component, and CF component
Medical care that is cost-shared by both Tricare Standard and a civilian source is known as
Cooperative care
A health care professional usualy a registered nurse who helps the patient work with his or her primary care manager to locate a specialist or obtain a preauthorization for care is referred toas a
HCF
The Veterans Health Care Expansion Act of 1973 authorized the
CHAMPVA program
RICARE Prime and TRICARE Extra claims are
filed by the provider to a TRICARE subcontractor
If a Tricare Extra claim is submitted with several items and several dates of service, the time limit that would apply to the claim for filling would be
Individual time limits for each item on the claim.
Cyst/o
Urinary bladder
Ped/o
Child
Epi
Above
Patho
genic
Neuralgia
Pain of nerves
Ertythrocyte
Blood cell that carries oxygen
Nephrectomy
Resection of a kidney
Thrombocyte
A platelet
Cystoscopy
Process of visual examination of the urinary bladder
Gastrotomy
Incision of the stomach
The instructions and conventions of the classification take precedence over
Official Coding Guidelines
In 1980 the AMA adopted a modern code of ethics called the
The Principles of Medical Ethics
FH
Family History
SH
Social History
ROS
Review of systems
R/O
Rule out