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Study sets matching "billing chapter 5"

43 terms
Chapter 5 Billing Terms
Medicaid
Federal Medicaid Assistance Percentage
Fiscal Agent
Early and Periodic Screening, Diagnosi…
assistance program that pays for health care services for peo…
payments made by the federal government based on a state's av…
organization that processes claims for a government program
prevention, early detection, and treatment program for childr…
Medicaid
assistance program that pays for health care services for peo…
Federal Medicaid Assistance Percentage
payments made by the federal government based on a state's av…
13 terms
Medical Billing (Chapter 5/Key Terms)
(APCs) ambulatory *payment classific…
(CMI) case mix index
(DRGs) diagnosis-related groups
DRG weight
A medicare payment classification for outpatient services
A measure of the clinical severity or resource requirements
A system of analyzing conditions and treatments for similar *…
Under the Medicare Inpatient Prospective Payment System, a na…
(APCs) ambulatory *payment classific…
A medicare payment classification for outpatient services
(CMI) case mix index
A measure of the clinical severity or resource requirements
33 terms
Chapter 5 Hospital Billing
abuse
ambulatory payment classification (APC)
base rate
case mix index (CMI)
Improper billing practices, such as billing for a noncovered…
Medicare payment classification for outpatient services.
Under the Medicare Inpatient Prospective Payment System, a nu…
A measure of the clinical severity or resource requirements o…
abuse
Improper billing practices, such as billing for a noncovered…
ambulatory payment classification (APC)
Medicare payment classification for outpatient services.
20 terms
Billing Insurance- Chapter 5
E-CODES ****
COMBINATION CODE
ICD-9-CM ***
PHYSICIAN FEE PROFILE
a classification of ICD9-CM coding to describe environmental…
a code from one section of the procedural code book combined…
a diagnosis code book that use a system for classifying disea…
a compilation of each physician's charges and the payments ma…
E-CODES ****
a classification of ICD9-CM coding to describe environmental…
COMBINATION CODE
a code from one section of the procedural code book combined…
33 terms
billing chapter 5
American Standard Code for Information…
assigns benefits
claim attachments
claims clearinghouse
is the most common format used for text files in computers an…
it authorizes the insurance company to send the payment direc…
supplemental documents that provide additional medical inform…
a company that receives claims from healthcare providers and…
American Standard Code for Information…
is the most common format used for text files in computers an…
assigns benefits
it authorizes the insurance company to send the payment direc…
32 terms
Chapter 5 Billing
The interaction between the healthcare…
The cycle of an insurance claim begins
To meet the ______________________ ser…
A very significant change that impacte…
The Health Insurance Claims Process
when a patient visits a health care provider, where the medic…
Medical Necessary Criteria
Health Insurance Portability and Accountability Act (HIPPA)
The interaction between the healthcare…
The Health Insurance Claims Process
The cycle of an insurance claim begins
when a patient visits a health care provider, where the medic…
9 terms
computer billing chapter 5
encounter
patient information form
Guarantor
subscriber
during the ___________ the physician reviews the information…
Includes:... patient name, name of primary insurance carrier, CO…
person who is the insurance policy holder for a patient
Policy holder
encounter
during the ___________ the physician reviews the information…
patient information form
Includes:... patient name, name of primary insurance carrier, CO…
39 terms
Chapter 5 Insurance and Billing
What is record retention?
What do medicare conditions of partici…
How long does HIPAA mandate retention…
How long does HIPAA mandate that healt…
Storage of documentation for an established period of time, u…
They mandate retention of patient records in the original or…
6 years.
2 years.
What is record retention?
Storage of documentation for an established period of time, u…
What do medicare conditions of partici…
They mandate retention of patient records in the original or…
32 terms
Chapter 5 medical billing
Medicare
CMS
End-stage renal disease
Medicare part A
Federal health insurance benefit for the aged and disabled.
Centers for Medicare and medical services organization that o…
Occurs when a patients kidneys fail to function.
Considered the basic plan or hospital insurance. Covers facil…
Medicare
Federal health insurance benefit for the aged and disabled.
CMS
Centers for Medicare and medical services organization that o…
23 terms
Insurance Billing- Chapter 5
Medicaid
FMAP (federal medicaid assistance perc…
Fiscal agent
EPSDT (early and periodic screening, d…
Assistance program that pays for health care services for peo…
Payments made by the federal government based on a states ave…
Organization that processes claims for a government program
Prevention, early detection, and treatment program for childr…
Medicaid
Assistance program that pays for health care services for peo…
FMAP (federal medicaid assistance perc…
Payments made by the federal government based on a states ave…
26 terms
Billing and Coding chapter 5
category 1 codes
category 2 codes
category 3 codes
section guidelines
procedure codes found in the main body of CPT
optional CPT codes that track performance measures
temporary codes for emerging technology, services, and proced…
usage notes at the beginning of CPT sections
category 1 codes
procedure codes found in the main body of CPT
category 2 codes
optional CPT codes that track performance measures
26 terms
Billing and Coding chapter 5
category 1 codes
category 2 codes
category 3 codes
section guidelines
procedure codes found in the main body of CPT
optional CPT codes that track performance measures
temporary codes for emerging technology, services, and proced…
usage notes at the beginning of CPT sections
category 1 codes
procedure codes found in the main body of CPT
category 2 codes
optional CPT codes that track performance measures
34 terms
Chapter 5 Payment methods and billing compliance by Margarette Thornwell
abuse
ambulatory payment classifications
base rate
benchmark
Any care that results in physical harm or pain, or mental ang…
Hospital outpatient prospective payment system HOPPS. The cla…
The relative proportions of different classes in a population…
making a comparison among different organizations relative to…
abuse
Any care that results in physical harm or pain, or mental ang…
ambulatory payment classifications
Hospital outpatient prospective payment system HOPPS. The cla…
Medical Billing and Coding Chapter 5
physician's fee profile
primary diagnosis
secondary diagnosis
etiology
Each physician's charges and the payments made to him or her…
The first listed condition (chief complaint) of a claim for a…
Listed after the primary diagnosis, may contribute to the con…
The underlying cause of a disease.
physician's fee profile
Each physician's charges and the payments made to him or her…
primary diagnosis
The first listed condition (chief complaint) of a claim for a…
34 terms
Hospital Billing Chapter 5 Tiffany Bradumn
Abuse
Ambulatory Payment Classifications (AP…
Base Rate
Benchmark
Improper billing practices, such as billing for noncovered se…
A medicare payment classification for outpatient services
Under the Medicare Inpatient Prospective Payment System a num…
To compare something against a standard ,such as an activity…
Abuse
Improper billing practices, such as billing for noncovered se…
Ambulatory Payment Classifications (AP…
A medicare payment classification for outpatient services
29 terms
Chapter 5 (Billing and Coding)
Professional component
Increased procedural service
Two surgeons
Multiple procedures
26; used to report professional components when a procedure h…
22; used with rare unusual or variable surgery services, requ…
62; used when a specific surgical procedure requires two surg…
51; used to identify a second procedure or multiple procedure…
Professional component
26; used to report professional components when a procedure h…
Increased procedural service
22; used with rare unusual or variable surgery services, requ…
11 terms
Computer billing Test 2 Chapter 5
Documents the patient's answers and th…
The name of the patient's primary insu…
however, if a patient is covered by so…
double-checked against the insurance c…
During the encounter, the physician reviews the information o…
A patient information form contains the following information..
the insured is the holder of the insurance policy that covers…
all data from the card that the patient has written on the pa…
Documents the patient's answers and th…
During the encounter, the physician reviews the information o…
The name of the patient's primary insu…
A patient information form contains the following information..
10 terms
Chapter 5 Bill Of Rights
First amendment
Second amendment
Third amendment
Fourth amendment
Basic freedoms :... Guarantees five basic freedoms religion , sp…
Rights of bear arms :... Protects the right to bear arms and for…
Quartering of soldiers :... places restrictions on the quarterin…
Search and seizure :... The right of the people to be secure in…
First amendment
Basic freedoms :... Guarantees five basic freedoms religion , sp…
Second amendment
Rights of bear arms :... Protects the right to bear arms and for…
10 terms
Computer Billing Chapter 5 and 6
Encounter
Patient information form
Insured
Policy
Dr reviews info on med history form, documents pts answers an…
Primary and secondary ins carriers
Holder of ins policy
Explains what is required of the pt and when pymt is due
Encounter
Dr reviews info on med history form, documents pts answers an…
Patient information form
Primary and secondary ins carriers
26 terms
chapter 5 Medical ins billing
assign benefits
abstract
beneficiary
claims clearinghouse
When a patient affixes his or her signature to a document tha…
theoretical; impersonal
A participant in a health insurance plan through the Medicare…
...
assign benefits
When a patient affixes his or her signature to a document tha…
abstract
theoretical; impersonal
45 terms
understanding hospital billing and coding chapter 5
Accept assignment
Accounts receivable(AR) management
Ambulatory Payment Classifications(APC)
Ambulatory surgery
an agreement between the hospital and payer that states the h…
Refers to functions required to monitor and follow-up on outs…
The Outpatient Prospective Payment System(OPPS) reimbursement…
Surgery that is performed on the same day the patient is disc…
Accept assignment
an agreement between the hospital and payer that states the h…
Accounts receivable(AR) management
Refers to functions required to monitor and follow-up on outs…
27 terms
Chapter 5 Rights/Liberties and Bill of Rights
1st Amendment
2nd Amendment
3rd Amendment
4th Amendment
Protect Freedom of Religion, Speech, Petition, Press, and Ass…
You have the right to own guns
The government cannot force people to keep troops in their pr…
Protection against Unreasonable Search and Seizure
1st Amendment
Protect Freedom of Religion, Speech, Petition, Press, and Ass…
2nd Amendment
You have the right to own guns
34 terms
Chapter 5 Payment Methods & Billing Compliance
abuse
ambulatory payment classifications
base rate
benchmark
Any care that results in physical harm or pain, or mental ang…
Hospital outpatient prospective payment system HOPPS. The cla…
The relative proportions of different classes in a population…
making a comparison among different organizations relative to…
abuse
Any care that results in physical harm or pain, or mental ang…
ambulatory payment classifications
Hospital outpatient prospective payment system HOPPS. The cla…
26 terms
Chapter 5 Rights/Liberties and Bill of Rights
1st Amendment
2nd Amendment
3rd Amendment
4th Amendment
Protect Freedom of Religion, Speech, Petition, Press, and Ass…
You have the right to own guns
The government cannot force people to keep troops in their pr…
Protection against Unreasonable Search and Seizure
1st Amendment
Protect Freedom of Religion, Speech, Petition, Press, and Ass…
2nd Amendment
You have the right to own guns
11 terms
chapter 5 bills interest and income tax
VAT stands for
when dealing with percentage profit or…
money you receive when you invest mone…
principal
Value added tax. it is a government taz
base the percentage on the cost price
interest
is the amount of money you invest
VAT stands for
Value added tax. it is a government taz
when dealing with percentage profit or…
base the percentage on the cost price
24 terms
Chapter 1 Billing Terms
Medical insurance
Policyholder
Health plan
Premium
agreement between a person and a health plan that enables ind…
individual who enters into an agreement with a health plan to…
organization that offers financial protection in case of illn…
fee paid monthly to a health plan by a person who buys medica…
Medical insurance
agreement between a person and a health plan that enables ind…
Policyholder
individual who enters into an agreement with a health plan to…
27 terms
Chapter 5 Rights/Liberties and Bill of Rights
1st Amendment
2nd Amendment
3rd Amendment
4th Amendment
Protect Freedom of Religion, Speech, Petition, Press, and Ass…
You have the right to own guns
The government cannot force people to keep troops in their pr…
Protection against Unreasonable Search and Seizure
1st Amendment
Protect Freedom of Religion, Speech, Petition, Press, and Ass…
2nd Amendment
You have the right to own guns
34 terms
Chapter 5 Hospital Billing Jasmine White
Abuse
Ambulatory Payment Classifications (AP…
Base Rate
Benchmark
Improper billing practices, such as billing for noncovered se…
A medicare payment classification for outpatient services
Under the Medicare Inpatient Prospective Payment System a num…
To compare something against a standard ,such as an activity…
Abuse
Improper billing practices, such as billing for noncovered se…
Ambulatory Payment Classifications (AP…
A medicare payment classification for outpatient services
34 terms
Chapter 5 Hospital Billing- Ebony Dinkins
Abuse
Ambulatory Payment Classifications (AP…
Base Rate
Benchmark
Improper billing practices, such as billing for noncovered se…
A medicare payment classification for outpatient services
Under the Medicare Inpatient Prospective Payment System a num…
To compare something against a standard ,such as an activity…
Abuse
Improper billing practices, such as billing for noncovered se…
Ambulatory Payment Classifications (AP…
A medicare payment classification for outpatient services
34 terms
Chapter 5 Hospital Billing- Ervin Asaka
Abuse
Ambulatory Payment Classifications (AP…
Base Rate
Benchmark
Improper billing practices, such as billing for noncovered se…
A medicare payment classification for outpatient services
Under the Medicare Inpatient Prospective Payment System a num…
To compare something against a standard ,such as an activity…
Abuse
Improper billing practices, such as billing for noncovered se…
Ambulatory Payment Classifications (AP…
A medicare payment classification for outpatient services
20 terms
Hospital billing vocab. Chapter 5-10
Ambulatory Payment Classification (APC)
Ambulatory Surgery
CMS-1450 (UB-40)
CMS- 1500
Reimbursement method used by Medicare and other government pr…
Surgery that is performed on the same day the patient is disc…
The uniform hard company of the claim form used by institutio…
The claim form used by non-institutional providers to submit…
Ambulatory Payment Classification (APC)
Reimbursement method used by Medicare and other government pr…
Ambulatory Surgery
Surgery that is performed on the same day the patient is disc…
54 terms
Medical Billing & Coding: Heald College: Chapter 5 | Diagnostic Coding
Why must diagnostic coding be accurate?
What is the Primary Diagnosis?
What is the Secondary Diagnosis?
What is the Principal Diagnosis?
1. Payment for inpatient services rendered to a patient may b…
1. Related to the chief complaint... 2. Main reason for the enco…
1. May contribute to the primary diagnosis... 2. Not the underly…
1. Only applicable to inpatient cases/claims... 2. Similar to pr…
Why must diagnostic coding be accurate?
1. Payment for inpatient services rendered to a patient may b…
What is the Primary Diagnosis?
1. Related to the chief complaint... 2. Main reason for the enco…
28 terms
Chapter 3 Billing Terms
Group Health Plan
Pharmacy Benefit Manager
Open Enrollment Period
Individual Health Plan
Health plan providing coverage to employees & families and su…
Responsible for processing and paying prescription drug claims
specific periods of time when employees choose a particular s…
Medical insurance plan purchased by an individual
Group Health Plan
Health plan providing coverage to employees & families and su…
Pharmacy Benefit Manager
Responsible for processing and paying prescription drug claims
34 terms
Chapter 5 Hospital Billing- Edith Watford
Abuse
Ambulatory Payment Classifications (AP…
Base Rate
Benchmark
Improper billing practices, such as billing for noncovered se…
A medicare payment classification for outpatient services
Under the Medicare Inpatient Prospective Payment System a num…
To compare something against a standard ,such as an activity…
Abuse
Improper billing practices, such as billing for noncovered se…
Ambulatory Payment Classifications (AP…
A medicare payment classification for outpatient services
22 terms
Chapter 5 Hospital Billing - Ashley Walton
abuse
ambulatory payment classification (APCs)
base rate
benchmark
impropper billing practices, such as billing for a noncovered…
a Medicare payment classification for outpatient services.
Under the Medicare Inpatient Prospective Payment System, a nu…
to compare something against a standard, such as an activity…
abuse
impropper billing practices, such as billing for a noncovered…
ambulatory payment classification (APCs)
a Medicare payment classification for outpatient services.
34 terms
Hospital Billing Chapter 5 Yolanda Davis
Abuse
Ambulatory Payment Classifications (AP…
Base Rate
Benchmark
Improper billing practices, such as billing for noncovered se…
A medicare payment classification for outpatient services
Under the Medicare Inpatient Prospective Payment System a num…
To compare something against a standard ,such as an activity…
Abuse
Improper billing practices, such as billing for noncovered se…
Ambulatory Payment Classifications (AP…
A medicare payment classification for outpatient services
34 terms
Hospital Billing Chapter 5 Joyce Crosby
Abuse
Ambulatory Payment Classifications (AP…
Base Rate
Benchmark
Improper billing practices, such as billing for noncovered se…
A medicare payment classification for outpatient services
Under the Medicare Inpatient Prospective Payment System a num…
To compare something against a standard ,such as an activity…
Abuse
Improper billing practices, such as billing for noncovered se…
Ambulatory Payment Classifications (AP…
A medicare payment classification for outpatient services
17 terms
Chapter 5 Bill of rights
First Amendment
Civil liberties
Civil rights
Incorporation
Guarentees freedom of speech, press, religion, assembely and…
Basic freedoms are guaranteed under the constitution, such as…
Guarantees of equal rights and equal treatment under the law.…
The process by which the Supreme Court applies the Bill of ri…
First Amendment
Guarentees freedom of speech, press, religion, assembely and…
Civil liberties
Basic freedoms are guaranteed under the constitution, such as…
15 terms
chapter 5 bill of rights
First amendment
Freedom of Religion
Freedom of speech
NOT PROTECTED BY FREE SPEECH:
guarantees various rights including speech, press, religion a…
2 parts:... The Establishment Clause ... Free Exercise Clause... stab…
is the freedom to say whatever you think and feel.
Libel: publishing false information with the intent to cause…
First amendment
guarantees various rights including speech, press, religion a…
Freedom of Religion
2 parts:... The Establishment Clause ... Free Exercise Clause... stab…
Bill of Rights- Chapter 5
first amendment
what are the 4 parts of the 1st Amendm…
libel
slander
protects various rights included free speech, press, religion…
freedom of speech, press, petition, and assembly
publishing false information about someone with intent to cau…
speaking false information with the intent to cause harm.
first amendment
protects various rights included free speech, press, religion…
what are the 4 parts of the 1st Amendm…
freedom of speech, press, petition, and assembly
12 terms
the bill of rights chapter 5
1.
2.
3.
4.
the patient has the right to considerate and respectful care.
the patient has the right to and is encouraged to obtain from…
the patient has the right to make decisions about the plan of…
the patient has the right to have an advance directive such a…
1.
the patient has the right to considerate and respectful care.
2.
the patient has the right to and is encouraged to obtain from…
39 terms
Chapter 2 Billing Terms
Centers for Medicare & Medicaid Servic…
Health Insurance Portability & Account…
Medical Records
Covered entities
This agency oversees Medicare and Medicaid. It establishes co…
the purpose was to improve portability and continuity of heal…
Patient's medication files and other clinical materials that…
health care providers and clearinghouses that transmit HIPAA…
Centers for Medicare & Medicaid Servic…
This agency oversees Medicare and Medicaid. It establishes co…
Health Insurance Portability & Account…
the purpose was to improve portability and continuity of heal…
42 terms
Chapter 5 (Billing and Basic Accounting Procedures)
Accounting equation
Balance
Bank draft
Blank endorsement
The relationship between the three basic accounting elements;…
The difference between total debits and credits in an account.
A check issued by a bank on its funds in another bank, usuall…
The simple signature of the payee which makes the check payab…
Accounting equation
The relationship between the three basic accounting elements;…
Balance
The difference between total debits and credits in an account.
8 terms
Chapter 5: The Bill of Rights
civil liberties
civil rights
incorporation
libel
basic freedoms guaranteed under the U.S. Constitution, such a…
guarantees of equal rights and equal treatment under the law,…
the process by which the Supreme Court applies the Bill of Ri…
publishing false information about someone with intent to cau…
civil liberties
basic freedoms guaranteed under the U.S. Constitution, such a…
civil rights
guarantees of equal rights and equal treatment under the law,…
8 terms
Chapter 5 Bill of Rights
The first amendment has 5 parts.
The second amendment
The third and fourth amendment
The fifth amendment
#1 is freedom of religion #2 is freedom of speech #3 is freed…
the right to bare arms...have a gun
Protecting your home and person
Your rights when accused of a crime
The first amendment has 5 parts.
#1 is freedom of religion #2 is freedom of speech #3 is freed…
The second amendment
the right to bare arms...have a gun
10 terms
Chapter 5 Bill of Right
First Amendment
Second Amendment
Third Amendment
Fourth Amendment
This amendment protects various rights including freedom of s…
This amendment is the right to bear arms.
This amendment is: no soldier should go into any persons hous…
This amendment is: Prevents unreasonable search and seizure.P…
First Amendment
This amendment protects various rights including freedom of s…
Second Amendment
This amendment is the right to bear arms.
10 terms
chapter 5 bill of rights
First amendment
second amendment
third amendment
fourth amendment
protects various rights including free speech,press,religion,…
THE RIGHT TO BEAR ARMS: most regulations of firearms is in th…
- prohibits citizens from being forced to take soldiers into…
forbids unreasonable searches and seizures of individuals or…
First amendment
protects various rights including free speech,press,religion,…
second amendment
THE RIGHT TO BEAR ARMS: most regulations of firearms is in th…
10 terms
Chapter 5: Bill of Rights
amendment 1
amendment 2
amendment 3
amendment 4
freedoms of religion, speech, press, assembly, and petition (…
right to bear arms (sts. rt to raise militia; ppl can protect…
(related to quartering act) citizens not forced to lodge troo…
unreasonable search, seizures, proper warrants (probable caus…
amendment 1
freedoms of religion, speech, press, assembly, and petition (…
amendment 2
right to bear arms (sts. rt to raise militia; ppl can protect…
26 terms
Bill of Right Chapter 5
First Amendment
Second Amendment
Third Amendment
Fourth Amendment
guarantees freedoms of speech,press,religion,assembly and pet…
Right to bear arms
prohibited citizens from being forced to take soldiers into t…
Gives people a certain amount of privacy
First Amendment
guarantees freedoms of speech,press,religion,assembly and pet…
Second Amendment
Right to bear arms
54 terms
Medical Billing & Coding: Heald College: Chapter 5 | Diagnostic Coding
Why must diagnostic coding be accurate?
What is the Primary Diagnosis?
What is the Secondary Diagnosis?
What is the Principal Diagnosis?
1. Payment for inpatient services rendered to a patient may b…
1. Related to the chief complaint... 2. Main reason for the enco…
1. May contribute to the primary diagnosis... 2. Not the underly…
1. Only applicable to inpatient cases/claims... 2. Similar to pr…
Why must diagnostic coding be accurate?
1. Payment for inpatient services rendered to a patient may b…
What is the Primary Diagnosis?
1. Related to the chief complaint... 2. Main reason for the enco…
1 of 10