A service that is rarely provided, unusual, variable, or new may require a __________ in determining medical appropriateness of the service.
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
The Principles of Medical Ethics
What is the name of the modern code of ethics that the American Medical Association (AMA) adopted in 1980?
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)
Pathology / Laboratory 80048-89356
Medicine 90281-99199 / 99500-99602
These symbols are used so that test does not need to be repeated for an entire range of codes
This symbol preceding a code means the code has undergone a revision to the description from the previous year
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.
This convention was added to highlight products that are awaiting U.S. Food and Drug Administration (FDA) approval
Significant, separately identifiable E & M service by the same physician on the day of a procedure
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
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
Why would conversion from a group policy to an individual policy be advantageous?
No physician examination required
Parts of the small and large intestines, right ovary, right uterine tube, appendix, and right ureter are found in the
Right lower quadrant
What is the name of the book used in the physicians office to code procedures?
Current Procedural Terminology (CPT)
Back and forth communicaiton between user and computer that occurs during on-line real time is called
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
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
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
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.
Organizations handling claims from hospitals, nursing facilities, intermediate care facilities, long-term care facilities, and home health agencies are called
The Omnibus Budget Reconciliation Act
Provided assistance for the aged and diabled who are receiving Medicare and whose incomes are below the poverty level.
What is the system called that TRICARE claims processors use to verify beneficiary eligibility?
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.
In a PD (permanent disability) claim, the physicians final report must include the words
Permanent and stationary
The form that accompanies the billing claim form for inpatient hospital services is called a
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
What is the correct term used to determine if a procedure is covered and medically necessary
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
A patient is diagnosed with inflammation of the testis and epididymis. The medical term for this condition is called
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
Medical care that is cost-shared by both Tricare Standard and a civilian source is known as
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
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.
The instructions and conventions of the classification take precedence over
Official Coding Guidelines